8/12/2020
Licensee Lookup Summary
Jurisdiction: Alabama
This document may serve in lieu of a Letter of Certification.
Licensee Demographics Name: MATRIX ABSENCE MANAGEMENT INC
NPN: 3486051
Domicile State: Arizona
Domicile Country: United States
Resident?: No
Business Address: PHOENIX, AZ 85029
License Quick View License Class
License Status
Status Date
Effective Date
Expiration Date
Adjuster
Active
12/16/2019
01/01/2020
12/31/2021
Phone, Email, Website Phone
Website No results found.
Type
Number
Type
Fax Phone
(602) 866-9707
Business Email
matrixlicensing@matrixcos.com
Business Primary Phone
(800) 866-2301
License Information License Type: Adjuster License Number: 3000257193
License Status: Active
Status Date: 12/16/2019
First Active Date: 03/13/2018
Effective Date: 01/01/2020
Expiration Date: 12/31/2021
Legacy License ID:
Line Of Authority Line Name
Qualification
Property & Casualty (incl WC & Crop)
Not Applicable
School Code
Exam/Cert Date
Line Status
Status Date
Effective Date
03/13/2018
Approved
12/16/2019
03/13/2018
DBA/Trade Name No results found.
Designated Responsible Licensed Producer Name
License #
NPN
License Class
License Status
Resident State
Start Date
KIMBERLY SMITH
246578
3599516
Adjuster
Active
Florida
03/13/2018
Appointments No results found.
Relationships No results found.
Owners, Partners, Officers and Directors Name
Designation
MICHAEL ASKINS
SVP FINANCE
Pct Owned
Owner No
Status Date
Start Date 03/13/2018
GLENN PEIRCE
VP, FINANCE AND TREASURER
No
03/13/2018
DONALD SHERMAN
DIRECTOR
No
03/13/2018
CHRISTOPHER FAZZINI
DIRECTOR
No
03/13/2018
KENNETH COPE
PRESIDENT AND CEO
No
03/13/2018
GORDON SMITH
VP AND CIO
No
03/13/2018
SUZANNE WILSON
VP AND SECRETARY
No
03/13/2018
CHARLES DENARO
VP AND GENERAL COUNSEL
No
03/13/2018
Business Entity Affiliations
NPN
Name
Related License #
Related License Type
Effective Date
1231996
STEVEN BETTS
3000325537
Adjuster
06/15/2018
Branch Office Information No results found. © 2020 National Association of Insurance Commissioners. All rights reserved.
Ex. P, p. 1
https://sbs.naic.org/solar-external-lookup/lookup/licensee/summary/3000257193?jurisdiction=AL&entityType=BE&licenseType=ADJ
1/2
8/12/2020
Licensee Lookup Summary
Jurisdiction: Alaska
This document may serve in lieu of a Letter of Certification.
Licensee Demographics Name: MATRIX ABSENCE MANAGEMENT INC
NPN: 3486051
Domicile State: Arizona
Domicile Country: United States
Resident?: No
Business Address: PHOENIX, AZ 85029
License Quick View License Class
License Status
Status Date
Effective Date
Expiration Date
Independent Adjuster
Active
10/01/2018
12/04/2018
12/03/2020
Third Party Administrator
Active
10/01/2018
12/04/2018
12/03/2020
Phone, Email, Website Phone
Website No results found.
Type
Number
Type
Business Primary Phone
(602) 866-2333
Business Email
matrix.licensing@matrixcos.com
Business Fax Phone
(408) 360-9441
Mailing Fax Phone
(602) 866-9707
License Information License Type: Independent Adjuster License Number: 91372
License Status: Active
Status Date: 10/01/2018
First Active Date: 12/03/2010
Effective Date: 12/04/2018
Expiration Date: 12/03/2020
Legacy License ID: 91372
Line Of Authority Line Name
Qualification
Line Status
Status Date
Effective Date
Property
Waiver
School Code
Exam/Cert Date
Approved
09/24/2018
12/03/2010
Casualty
Waiver
Approved
09/24/2018
12/03/2010
Designated Responsible Licensed Producer Name
License #
NPN
License Class
License Status
Resident State
Start Date
TONY MYERS
34450
7823560
Independent Adjuster
Active
Oregon
06/26/2017
Owners, Partners, Officers and Directors No results found.
DBA/Trade Name No results found.
© 2020 National Association of Insurance Commissioners. All rights reserved.
Ex. P, p. 2
https://sbs.naic.org/solar-external-lookup/lookup/licensee/summary/91372?jurisdiction=AK&entityType=BE&licenseType=IA
1/1
8/12/2020
Licensee Lookup Summary
Jurisdiction: Alaska
This document may serve in lieu of a Letter of Certification.
Licensee Demographics Name: MATRIX ABSENCE MANAGEMENT INC
NPN: 3486051
Domicile State: Arizona
Domicile Country: United States
Resident?: No
Business Address: PHOENIX, AZ 85029
License Quick View License Class
License Status
Status Date
Effective Date
Expiration Date
Independent Adjuster
Active
10/01/2018
12/04/2018
12/03/2020
Third Party Administrator
Active
10/01/2018
12/04/2018
12/03/2020
Phone, Email, Website Phone
Website No results found.
Type
Number
Type
Business Primary Phone
(602) 866-2333
Business Email
matrixlicensing@matrixcos.com
Business Fax Phone
(408) 360-9441
Mailing Fax Phone
(602) 866-9707
License Information License Type: Third Party Administrator License Number: 91372
License Status: Active
Status Date: 10/01/2018
First Active Date: 08/05/2015
Effective Date: 12/04/2018
Expiration Date: 12/03/2020
Legacy License ID:
Line Of Authority Line Name
Qualification
School Code
Health
Exam/Cert Date
Line Status
Status Date
Effective Date
08/05/2015
Approved
08/05/2015
08/05/2015
Designated Responsible Licensed Producer Name
License #
NPN
License Class
License Status
Resident State
Start Date
TONY MYERS
34450
7823560
Third Party Administrator
Active
Oregon
06/26/2017
Owners, Partners, Officers and Directors No results found.
DBA/Trade Name No results found.
© 2020 National Association of Insurance Commissioners. All rights reserved.
Ex. P, p. 3
https://sbs.naic.org/solar-external-lookup/lookup/licensee/summary/91372?jurisdiction=AK&entityType=BE&licenseType=TPA
1/1
8/12/2020
Company Lookup Summary
Jurisdiction: Arizona
Demographics Company Name: MATRIX ABSENCE MANAGEMENT, INC.
Short Name: MATRIX ABS
SBS Company Number: 49206640
NAIC CoCode:
FEIN:
Domicile Type: Foreign
State of Domicile: Delaware
Country of Domicile: United States
NAIC Group Number:
Organization Type: ASSOCIATION
Date of Incorporation:
Merger Flag: No
DBA Name No results found.
Address Business Address
Mailing Address
Statutory Home Office Address
Main Administrative Office Address
2421 W Peoria Avenue, Suite 200 Peoria, AZ 85029
2421 W Peoria Avenue, Suite 200 Peoria, AZ 85029
181 METRO DRIVE, SUITE 300 SAN JOSE, CA 95110
2421 W Peoria Avenue, Suite 200 Peoria, AZ 85029
United States
United States
United States
United States
Phone, Email, Website Phone
Type
Number
Fax Phone
(602) 866-9707
Business Primary Phone
(602) 866-2333
Website
No results found.
No results found.
Company Type Company Type: Life & Health Administrator Status: Active
Status Reason:
Effective Date: 11/10/2009
Legacy State ID: 2453
Status Date: 03/15/2019 Expiration Date: 03/01/2021
Issue Date: 11/10/2009
Approval Date: 01/29/2020
File Date: 01/29/2020
Articles of Incorporation Received: No
Article No:
COA Number:
Line Of Business Line of Business
Citation Type
Life & Health Administrator
Effective Date 11/10/2009
Contact Contact Type
Preferred Name
TREASURER
Name
MICHAEL FREDERICKSEN
Phone Business Primary Phone: (408) 360-8370
Address Other 5225 HELLYER AVENUE, STE 210 SAN JOSE, CA United States County 95103
PRESIDENT
SILVIA DAURELLE
Business Primary Phone: (602) 866-2333
Other 2421 W. PEORIA AVE. SUITE 200 PHOENIX, AZ United States County 85029
STATUTORY AGENT
CT Corp System
Other 3800 N Central Ave suite 460 PHOENIX, AZ United States County 85012
VICE PRESIDENT
ROBERT SMITH
Business Primary Phone: (408) 360-8370
Other 4225 HELLYER AVENUE, STE 210 SAN JOSE, CA United States County 95103
Branch Offices Company Merger No results found.
Name Change History No results found.
© 2020 National Association of Insurance Commissioners. All rights reserved.
https://sbs.naic.org/solar-external-lookup/lookup/company/summary/49206640?jurisdiction=AZ
Ex. P, p. 4
1/1
8/12/2020
Licensee Lookup Summary
Jurisdiction: Arizona
Licensee Demographics Name: MATRIX ABSENCE MANAGEMENT INC
NPN: 3486051
Domicile State: Arizona
Domicile Country: United States
Resident?: Yes
Business Address: PHOENIX, AZ 85029
License Quick View License Class
License Status
Status Date
Effective Date
Expiration Date
Adjuster
Active
02/08/2019
04/01/2019
03/31/2023
Phone, Email, Website Phone
Website No results found.
Type
Number
Type
Business Primary Phone
(602) 866-2333
Business Email
debra.harris@matrixcos.com
License Information License Type: Adjuster License Number: 1800013328
License Status: Active
Status Date: 02/08/2019
First Active Date: 03/10/2015
Effective Date: 04/01/2019
Expiration Date: 03/31/2023
Legacy License ID: 1105701
Line Of Authority Line Name
Qualification
Adjuster
Exam
School Code
Exam/Cert Date
Line Status
Status Date
Effective Date
03/10/2015
Approved
02/08/2019
03/10/2015
Designated Responsible Licensed Producer Name
License #
NPN
License Class
License Status
Resident State
SIMONE GDANSKI-HILTON
1236523
1236523
Adjuster
Active
Texas
Start Date
Owners, Partners, Officers and Directors Show 10
entries
Name
Showing 1 to 10 of 12 entries Designation
Pct Owned
Owner
BERNSTEIN, RICK
No
WILSON, SUZANNE
No
MAY, SANDRA LEE (FP:7/27/15)
No
COPE, KENNETH
No
PIERCE, GLENN
No
STAPLES, DEBRA
No
SHERMAN, DONALD
No
SCHUTZ, WILLIAM
No
DAURELLE, LAWRENCE
No
DENARO, CHARLES
No
Filter
Status Date
First
Start Date
Previous
1
2
Next
Last
Branch Office Information No results found.
DBA/Trade Name No results found.
© 2020 National Association of Insurance Commissioners. All rights reserved.
Ex. P, p. 5
https://sbs.naic.org/solar-external-lookup/lookup/licensee/summary/1800013328?jurisdiction=AZ&entityType=BE&licenseType=ADJ
1/1
8/12/2020
Licensee Lookup Summary
Jurisdiction: Arkansas
Licensee Demographics Name: Matrix Absence Management Inc.
NPN: 3486051
Domicile State: Arizona
Domicile Country: United States
Resident?: No
Business Address: PHOENIX, AZ 85029
License Quick View License Class
License Status
Status Date
Effective Date
Expiration Date
Adjuster
Active
07/23/2020
10/01/2020
09/30/2021
Third Party Administrator
Active
11/01/2019
01/01/2020
12/31/2020
Phone, Email, Website Phone
Website No results found.
Type
Number
Type
Business Primary Phone
(800) 866-2301
Business Email
matrixlicensing@matrixcos.com
Business Fax Phone
(602) 866-9707
Fax Phone
(602) 866-9707
License Information License Type: Third Party Administrator License Number: 100115128
License Status: Active
Status Date: 11/01/2019
First Active Date: 04/06/2004
Effective Date: 01/01/2020
Expiration Date: 12/31/2020
Legacy License ID: 266660
Line Of Authority No results found.
Designated Responsible Licensed Producer No results found.
Relationships No results found.
Business Entity Affiliations
NPN
Name
Related License #
Related License Type
Effective Date
7971233
ROBIN KIDDER
7971233
Adjuster
03/07/2018
Owners, Partners, Officers and Directors No results found.
Branch Office Information No results found.
DBA/Trade Name No results found.
Appointments No results found.
© 2020 National Association of Insurance Commissioners. All rights reserved.
Ex. P, p. 6
https://sbs.naic.org/solar-external-lookup/lookup/licensee/summary/100115128?jurisdiction=AR&entityType=BE&licenseType=TPA
1/1
8/12/2020
Licensee Lookup Summary
Jurisdiction: Arkansas
Licensee Demographics Name: Matrix Absence Management Inc.
NPN: 3486051
Domicile State: Arizona
Domicile Country: United States
Resident?: No
Business Address: PHOENIX, AZ 85029
License Quick View License Class
License Status
Status Date
Effective Date
Expiration Date
Adjuster
Active
07/23/2020
10/01/2020
09/30/2021
Third Party Administrator
Active
11/01/2019
01/01/2020
12/31/2020
Phone, Email, Website Phone
Website No results found.
Type
Number
Type
Business Primary Phone
(800) 866-2301
Business Email
matrixlicensing@matrixcos.com
Fax Phone
(602) 866-9707
Business Fax Phone
(602) 866-9707
License Information License Type: Adjuster License Number: 100115128
License Status: Active
Status Date: 07/23/2020
First Active Date: 03/08/2018
Effective Date: 10/01/2020
Expiration Date: 09/30/2021
Legacy License ID:
Line Of Authority Line Name
Qualification
Exam/Cert Date
Line Status
Status Date
Effective Date
Casualty
Reciprocity
School Code
03/08/2018
Approved
07/23/2020
03/08/2018
Workers Compensation
Reciprocity
03/08/2018
Approved
07/23/2020
03/08/2018
Property
Reciprocity
03/08/2018
Approved
07/23/2020
03/08/2018
Designated Responsible Licensed Producer Name
License #
NPN
License Class
License Status
Resident State
Start Date
Lee Littrell
1228804
1228804
Adjuster
Active
Texas
03/08/2018
Relationships
Related License #
Related Licensee Name
Related License Type
Effective Date
1228804
Lee Littrell
Adjuster
07/23/2020
Business Entity Affiliations
NPN
Name
Related License #
Related License Type
Effective Date
1231996
STEVEN BETTS
1231996
Adjuster
05/25/2018
17369578
SEAN MCGUIRE
17369578
Adjuster
09/11/2018
Owners, Partners, Officers and Directors No results found.
Branch Office Information No results found.
DBA/Trade Name No results found.
Appointments No results found. © 2020 National Association of Insurance Commissioners. All rights reserved.
Ex. P, p. 7
https://sbs.naic.org/solar-external-lookup/lookup/licensee/summary/100115128?jurisdiction=AR&entityType=BE&licenseType=ADJ
1/2
8/12/2020
Licensee Lookup Summary
Jurisdiction: Iowa
This document may serve in lieu of a Letter of Certification.
Licensee Demographics Name: MATRIX ABSENCE MANAGEMENT INC
NPN: 3486051
Domicile State: Arizona
Domicile Country: United States
Resident?: No
Business Address: PHOENIX, AZ 85029
License Quick View License Class
License Status
Status Date
Effective Date
Expiration Date
Third Party Administrator
Active
05/25/2018
06/27/2018
06/26/2021
Phone, Email, Website Phone
Website
Type
Number
Type
Business Primary Phone
(602) 866-2333 x52087
Business Email
assist@license-support.com
Mailing Fax Phone
(602) 866-9707
No results found.
License Information License Type: Third Party Administrator License Number: 1002253099
License Status: Active
Status Date: 05/25/2018
First Active Date: 06/26/2015
Effective Date: 06/27/2018
Expiration Date: 06/26/2021
Legacy License ID:
Line Of Authority No results found.
Designated Responsible Licensed Producer No results found.
Owners, Partners, Officers and Directors No results found.
Relationships No results found.
DBA/Trade Name No results found.
Business Entity Affiliations No results found.
Appointments No results found.
© 2020 National Association of Insurance Commissioners. All rights reserved.
Ex. P, p. 8
https://sbs.naic.org/solar-external-lookup/lookup/licensee/summary/1002253099?jurisdiction=IA&entityType=BE&licenseType=TPA
1/1
8/12/2020
Licensee Lookup Summary
Jurisdiction: Illinois
Licensee Demographics Name: MATRIX ABSENCE MANAGEMENT INC
NPN: 3486051
Domicile State: California
Domicile Country: United States
Resident?: No
Business Address: PHOENIX, AZ 85029
License Quick View License Class
License Status
Status Date
Effective Date
Expiration Date
THIRD PARTY ADMINISTRATOR
Active
05/06/2020
06/10/2020
06/09/2021
Phone, Email, Website Phone
Website
Type
Number
Type
Mailing Primary Phone
(602) 866-2333
Business Email
DEBRA.HARRIS@matrixcos.com
Business Primary Phone
(602) 866-2301
No results found.
License Information License Type: THIRD PARTY ADMINISTRATOR License Number: 100318747
License Status: Active
Status Date: 05/06/2020
First Active Date: 06/09/1998
Effective Date: 06/10/2020
Expiration Date: 06/09/2021
Legacy License ID:
Line Of Authority No results found.
Designated Responsible Licensed Producer No results found.
Relationships No results found.
Business Entity Affiliations No results found.
Owners, Partners, Officers and Directors No results found.
Branch Office Information No results found.
DBA/Trade Name No results found.
Appointments No results found.
© 2020 National Association of Insurance Commissioners. All rights reserved.
Ex. P, p. 9
https://sbs.naic.org/solar-external-lookup/lookup/licensee/summary/100318747?jurisdiction=IL&entityType=BE&licenseType=TPA
1/1
8/12/2020
Licensee Lookup Summary
Jurisdiction: Maryland
This document may serve in lieu of a Letter of Certification.
Licensee Demographics Name: Matrix Absence Management Inc
NPN: 3486051
Domicile State: California
Domicile Country: United States
Resident?: No
Business Address: PHOENIX, AZ 85029
License Quick View License Class
License Status
Status Date
Effective Date
Expiration Date
Third Party Administrator
Active
07/01/2019
07/01/2019
06/30/2021
Phone, Email, Website Phone
Website
Type
Number
Type
Business Primary Phone
(800) 866-2301
Business Email
matrix.licensing@matrixcos.com
Fax Phone
(602) 866-9707
No results found.
License Information License Type: Third Party Administrator License Number: 150593
License Status: Active
Status Date: 07/01/2019
First Active Date: 12/15/2000
Effective Date: 07/01/2019
Expiration Date: 06/30/2021
Legacy License ID: 150593
Line Of Authority No results found.
Designated Responsible Licensed Producer No results found.
Relationships No results found.
Business Entity Affiliations No results found.
Owners, Partners, Officers and Directors Show 10
Showing 1 to 10 of 13 entries
entries
Pct Owned
Filter
Name
Designation
KENNETH FLOYD COPE
Owner,CEO
No
05/06/2013
WILLIAM MORGAN SCHUTZ
CHIEF OPERATING OFF
No
06/11/2013
GORDON PATRICK SMITH
Officers,VP/CHIEF INFO OFFICE
No
06/11/2013
KENNETH COPE
DIRECTOR
No
04/21/2017
04/21/2017
DONALD SHERMAN
DIRECTOR
No
04/21/2017
04/21/2017
SUZANNE WILSON
VICE PRESIDENT & SECRETARY
No
04/21/2017
04/21/2017
CHRISTOPHER FAZZZINI
DIRECTOR
No
04/21/2017
04/21/2017
GORDON P. SMITH
VICE PRESIDENT & CHIEF INFORMATION OFFICER
No
04/21/2017
04/21/2017
GLENN PIERCE
VICE PRESIDENT & TREASURER
No
04/21/2017
04/21/2017
No
03/15/2017
03/15/2017
MICHAEL ASKINS
Owner
First
Status Date
Previous
Start Date
1
2
Next
Last
Branch Office Information No results found.
DBA/Trade Name No results found.
Appointments No results found. © 2020 National Association of Insurance Commissioners. All rights reserved.
Ex. P, p. 10
https://sbs.naic.org/solar-external-lookup/lookup/licensee/summary/150593?jurisdiction=MD&entityType=BE&licenseType=TPA
1/2
8/12/2020
Licensee Lookup Summary
Jurisdiction: Delaware
Licensee Demographics Name: MATRIX ABSENCE MANAGEMENT INC
NPN: 3486051
Domicile State: Arizona
Domicile Country: United States
Resident?: No
Business Address: PHOENIX, AZ 85029
License Quick View License Class
License Status
Status Date
Effective Date
Expiration Date
ADJUSTER
Active
12/17/2018
03/01/2019
02/28/2021
Phone, Email, Website Phone
Website No results found.
Type
Number
Type
Fax Phone
(602) 866-9707
Business Email
debra.harris@matrixcos.com
Business Primary Phone
(602) 866-2333
License Information License Type: ADJUSTER License Number: 3000253724
License Status: Active
Status Date: 12/17/2018
First Active Date: 03/08/2018
Effective Date: 03/01/2019
Expiration Date: 02/28/2021
Legacy License ID:
Line Of Authority No results found.
Designated Responsible Licensed Producer Name
License #
NPN
License Class
License Status
Resident State
Start Date
STEVEN BETTS
3000312104
1231996
ADJUSTER
Active
Texas
07/06/2018
Relationships No results found.
Business Entity Affiliations
NPN
Name
Related License #
Related License Type
Effective Date
1231996
STEVEN BETTS
3000312104
ADJUSTER
05/29/2018
17369578
SEAN MCGUIRE
3000383518
ADJUSTER
09/11/2018
Owners, Partners, Officers and Directors Name
Designation
GORDON SMITH
VP AND CIO
Pct Owned
Owner No
Status Date
Start Date 03/08/2018
CHRISTOPHER FAZZINI
DIRECTOR
No
03/08/2018
MICHAEL ASKINS
SVP FINANCE
No
03/08/2018
KENNETH COPE
PRESIDENT AND CEO
No
03/08/2018
SUZANNE WILSON
VP AND SECRETARY
No
03/08/2018
DONALD SHERMAN
DIRECTOR
No
03/08/2018
GLENN PEIRCE
VP, FINANCE AND TREASURER
No
03/08/2018
CHARLES DENARO
VP AND GENERAL COUNSEL
No
03/08/2018
Branch Office Information No results found.
DBA/Trade Name No results found.
Appointments No results found.
© 2020 National Association of Insurance Commissioners. All rights reserved.
Ex. P, p. 11
https://sbs.naic.org/solar-external-lookup/lookup/licensee/summary/3000253724?jurisdiction=DE&entityType=BE&licenseType=04
1/2
8/12/2020
Company Lookup Summary
Jurisdiction: Missouri
Demographics Company Name: MATRIX ABSENCE MANAGEMENT INC
Short Name:
SBS Company Number: 104348832
NAIC CoCode:
FEIN:
Domicile Type: Foreign
State of Domicile: Delaware
Country of Domicile: United States
NAIC Group Number:
Organization Type: Corporation
Date of Incorporation: 12/07/2006
Merger Flag: No
DBA Name No results found.
Address Business Address
Mailing Address
Statutory Home Office Address
Main Administrative Office Address
Attn: Silvia Lee 2421 W PEORIA AVE SUITE 200
Attn: Silvia Lee 2421 W PEORIA AVE SUITE 200
Attn: Silvia Lee 2421 W PEORIA AVE SUITE 200
Attn: Silvia Lee 2421 W PEORIA AVE SUITE 200
PHOENIX, AZ 85029 United States
PHOENIX, AZ 85029 United States
PHOENIX, AZ 85029 United States
PHOENIX, AZ 85029 United States
Phone, Email, Website Phone
Type
Number
Business Primary Phone
(602) 866-2333
Mailing Primary Phone
(602) 866-2333
Statutory Home Office Primary Phone
(602) 866-2333
Main Admin Office Primary Phone
(602) 866-2333
Website
No results found.
No results found.
Company Type Company Type: Third Party Administrator (Ch 376.1075 - 376.1095 RSMo) Status: Active
Status Reason:
Status Date: 05/15/2009
Effective Date: 05/13/2009
Legacy State ID: 426009
Expiration Date: 07/01/2021
Issue Date: 05/13/2009
Approval Date: 05/15/2009
File Date: 05/15/2009
Articles of Incorporation Received: No
Article No:
COA Number:
Line Of Business No results found.
Contact No results found.
Company Merger No results found.
Name Change History Previous Name
New Name
Effective Date
MATRIX ABSENCE MANAGEMENT INC
© 2020 National Association of Insurance Commissioners. All rights reserved.
Ex. P, p. 12
https://sbs.naic.org/solar-external-lookup/lookup/company/summary/104348832?jurisdiction=MO
1/1
8/12/2020
Company Lookup Summary
Jurisdiction: Montana
Demographics Company Name: MATRIX ABSENCE MANAGEMENT, INC.
Short Name:
SBS Company Number: 29181531
NAIC CoCode:
FEIN: 77-0493584
Domicile Type: Foreign
State of Domicile: Delaware
Country of Domicile: United States
NAIC Group Number:
Organization Type: Corporation
Date of Incorporation: 06/29/1998
Merger Flag: No
DBA Name No results found.
Address Business Address
Mailing Address
Statutory Home Office Address
Main Administrative Office Address
2421 W PEORIA AVE STE 200 PHOENIX, AZ 85029
2421 W PEORIA AVE STE 200 PHOENIX, AZ 85029
THE CORPORATION TRUST COMPANY 1209 ORANGE STREET
2421 W PEORIA AVE STE 200 PHOENIX, AZ 85029
United States
United States
WILMINGTON, DE 19801 United States
United States
Phone, Email, Website Phone
Website
Type
Number
Type
Fax Phone
(602) 866-9707
Main Admin Office Email DEBRA.HARRIS@MATRIXCOS.COM
Toll Free Phone
(800) 866-2301
Business Primary Phone
(800) 866-2301 x54091
Mailing Primary Phone
(602) 866-2333 x52087
No results found.
MATRIX.LICENSING@MATRIXCOS.COM
Company Type Company Type: Third Party Administrator Status: Active
Status Reason:
Status Date: 12/21/2015
Effective Date: 12/21/2015
Legacy State ID: 378054
Expiration Date:
Issue Date: 12/21/2015
Approval Date:
File Date:
Articles of Incorporation Received: No
Article No:
COA Number: 562
Appointments No results found.
Line Of Business No results found.
Contact Contact Type
Preferred Name
Other
Name
DEBRA HARRIS
Phone Toll Free Phone: (800) 866-2301
Address Mailing Address 2421 W PEORIA AVE STE 200 PHOENIX, AZ United States County 85029
Branch Offices Company Merger No results found.
Name Change History Previous Name
New Name
Effective Date
MATRIX ABSENCE MANAGEMENT, INC.
© 2020 National Association of Insurance Commissioners. All rights reserved.
Ex. P, p. 13
https://sbs.naic.org/solar-external-lookup/lookup/company/summary/29181531?jurisdiction=MT
1/1
8/12/2020
Licensee Lookup Summary
Jurisdiction: North Dakota
Licensee Demographics Name: MATRIX ABSENCE MANAGEMENT INC
NPN: 3486051
Domicile State: Arizona
Domicile Country: United States
Resident?: No
Business Address: PHOENIX, AZ 85029
License Quick View License Class
License Status
Status Date
Effective Date
Expiration Date
Third-Party Administrator
Active
02/01/2020
05/01/2020
04/30/2021
Phone, Email, Website Phone
Website
Type
Number
Type
Type
Website
Business Primary Phone
(800) 866-2301
Business Email
matrixlicensing@matrixcos.com
Business URL
WWW.MATRIXCOS.COM
Business Fax Phone
(602) 866-9707
Fax Phone
(602) 866-9707
License Information License Type: Third-Party Administrator License Number: 2000144683
License Status: Active
Status Date: 02/01/2020
First Active Date: 06/19/2015
Effective Date: 05/01/2020
Expiration Date: 04/30/2021
Legacy License ID:
Line Of Authority No results found.
Designated Responsible Licensed Producer No results found.
Relationships No results found.
Branch Office Information No results found.
DBA/Trade Name No results found.
Appointments No results found.
Info
x
No Results Found. © 2020 National Association of Insurance Commissioners. All rights reserved.
Ex. P, p. 14
https://sbs.naic.org/solar-external-lookup/lookup/licensee/summary/2000144683?jurisdiction=ND&entityType=BE&licenseType=TPA
1/1
8/12/2020
Company Lookup Summary
Jurisdiction: Nebraska
Demographics Company Name: MATRIX ABSENCE MANAGEMENT, INC.
Short Name:
SBS Company Number: 59227278
NAIC CoCode:
FEIN: 77-0493584
Domicile Type: Foreign
State of Domicile: California
Country of Domicile: United States
NAIC Group Number:
Organization Type: Other
Date of Incorporation: 07/01/1998
Merger Flag: No
DBA Name No results found.
Address Business Address
Mailing Address
Statutory Home Office Address
Main Administrative Office Address
2421 W. PEORIA AVE, STE #200 PHOENIX, AZ 85029
2421 W. PEORIA AVE, STE #200 PHOENIX, AZ 85029
Not Available Not Available, UN 99999
2421 W. PEORIA AVE, STE #200 PHOENIX, AZ 85029
United States
United States
United States
United States
Phone, Email, Website Phone
Type
Number
Business Primary Phone
(602) 866-2323
Mailing Primary Phone
(602) 866-2323
Main Admin Office Primary Phone
(602) 866-2323
Website
No results found.
No results found.
Company Type Company Type: Third Party Administrators Status: Active
Status Reason:
Status Date: 03/06/2009
Effective Date: 03/06/2009
Legacy State ID: 151964
Expiration Date:
Issue Date: 03/06/2009
Approval Date:
File Date:
Articles of Incorporation Received: No
Article No:
COA Number:
Appointments No results found.
Line Of Business No results found.
Contact No results found.
Branch Offices Company Merger No results found.
Name Change History Previous Name
New Name
Effective Date
MATRIX ABSENCE MANAGEMENT, INC.
03/06/2009
© 2020 National Association of Insurance Commissioners. All rights reserved.
Ex. P, p. 15
https://sbs.naic.org/solar-external-lookup/lookup/company/summary/59227278?jurisdiction=NE
1/1
8/12/2020
Company Lookup Summary
Jurisdiction: New Hampshire
Demographics Company Name: MATRIX ABSENCE MANAGEMENT, INC.
Short Name: MATRIX ABSENCE MANAGEMENT INC
SBS Company Number: 89278926
NAIC CoCode:
FEIN:
Domicile Type: Foreign
State of Domicile: Delaware
Country of Domicile: United States
NAIC Group Number:
Organization Type: N/A
Date of Incorporation:
Merger Flag: No
DBA Name No results found.
Address Business Address
Mailing Address
Statutory Home Office Address
Main Administrative Office Address
181 METRO DRIVE, SUITE 300 SAN JOSE, CA 95110
2421 W. PEORIA AVENUE, STE 200 PHOENIX, AZ 85029
181 METRO DRIVE, SUITE 300 SAN JOSE, CA 95110
181 METRO DRIVE, SUITE 300 SAN JOSE, CA 95110
United States
United States
United States
United States
Phone, Email, Website Phone
No results found.
Website
Type
Business Email
DEBRA.HARRIS@matrixcos.com
Main Admin Office Email
DEBRA.HARRIS@matrixcos.com
Mailing Email
debra.harris@matrixcos.com
Statutory Home Office Email
DEBRA.HARRIS@matrixcos.com
No results found.
Company Type Company Type: Third Party Administrator -Licensed Status: Active
Status Reason:
Status Date: 12/02/2014
Effective Date: 12/02/2014
Legacy State ID: 104577
Expiration Date: 06/14/2021
Issue Date: 09/29/2009
Approval Date: 12/02/2014
File Date: 12/02/2014
Articles of Incorporation Received: No
Article No:
COA Number:
Appointments No results found.
Line Of Business Line of Business
Citation Type
Effective Date
TPA -Approved
402-H - TPA -Licensed & Approved
12/02/2014
Contact No results found.
Company Merger No results found.
Name Change History Previous Name
New Name
Effective Date
MATRIX ABSENCE MANAGEMENT, INC.
© 2020 National Association of Insurance Commissioners. All rights reserved.
Ex. P, p. 16
https://sbs.naic.org/solar-external-lookup/lookup/company/summary/89278926?jurisdiction=NH
1/1
8/12/2020
Licensee Lookup Summary
Jurisdiction: New Mexico
Licensee Demographics Name: Matrix Absence Management, Inc.
NPN: 3486051
Domicile State: Arizona
Domicile Country: United States
Resident?: No
Business Address: PHOENIX, AZ 85029
License Quick View License Class
License Status
Status Date
Effective Date
Expiration Date
Independent Adjuster
Active
02/07/2019
05/01/2019
04/30/2021
Third Party Admin
Active
02/04/2020
05/01/2020
04/30/2022
Phone, Email, Website Phone
Website No results found.
Type
Number
Type
Business Primary Phone
(800) 866-2301
Business Email
matrixlicensing@matrixcos.com
Fax Phone
(602) 866-9707
License Information License Type: Third Party Admin License Number: 1800003162
License Status: Active
Status Date: 02/04/2020
First Active Date: 03/04/2009
Effective Date: 05/01/2020
Expiration Date: 04/30/2022
Legacy License ID: 550765
Line Of Authority Line Name
Qualification
Casualty
Exam
School Code
Exam/Cert Date
Line Status
Status Date
Effective Date
Approved
02/04/2020
04/27/2017
Designated Responsible Licensed Producer No results found.
Relationships No results found.
Business Entity Affiliations No results found.
Owners, Partners, Officers and Directors Name
Designation
Christopher Fazzini
Director
Pct Owned
Owner No
Status Date
Start Date 09/18/2017
Donald Sherman
Director
No
09/18/2017
Kenneth Cope
President/CEO
No
09/18/2017
Glenn Pierce
VP, FINANCE AND TREASURER
No
09/18/2017
Suzanne Wilson
VP, Secretary
No
09/18/2017
Michael Askins
SVP, Finance
No
09/18/2017
Charles Denaro
VP, General Counsel
No
09/18/2017
Gordon Smith
VP and CIO
No
09/18/2017
Branch Office Information No results found.
© 2020 National Association of Insurance Commissioners. All rights reserved.
Ex. P, p. 17
https://sbs.naic.org/solar-external-lookup/lookup/licensee/summary/1800003162?jurisdiction=NM&entityType=BE&licenseType=TPA
1/1
8/12/2020
Company Lookup Summary
Jurisdiction: Oklahoma
Demographics Company Name: MATRIX ABSENCE MANAGEMENT, INC.
Short Name:
SBS Company Number: 44200444
NAIC CoCode:
FEIN: 77-0493584
Domicile Type: Foreign
State of Domicile: Arizona
Country of Domicile: United States
NAIC Group Number:
Organization Type: Corporation
Date of Incorporation:
Merger Flag: No
DBA Name No results found.
Address Business Address
Mailing Address
Statutory Home Office Address
Main Administrative Office Address
2421 W PEORIA AVE STE 200 PHOENIX, AZ 85029
2421 W PEORIA AVE STE 200 PHOENIX, AZ 85029
2421 W PEORIA AVE STE 200 PHOENIX, AZ 85029
2421 W PEORIA AVE STE 200 PHOENIX, AZ 85029
United States
United States
United States
United States
Phone, Email, Website Phone
Website
Type
Number
Type
Business Primary Phone
(800) 866-2301 x54091
Business Email
matrix.licensing@matrixcos.com
No results found.
Company Type Company Type: Third Party Administrator Status: Active
Status Reason:
Status Date: 11/22/2016
Effective Date: 12/01/2016
Legacy State ID: 863742
Expiration Date: 11/30/2020
Issue Date: 11/27/2000
Approval Date:
File Date: 11/27/2000
Articles of Incorporation Received: No
Article No:
COA Number:
Appointments No results found.
Line Of Business No results found.
Contact No results found.
Company Merger No results found.
Name Change History Previous Name
New Name
Effective Date
MATRIX ABSENCE MGMT.,INC. MATRIX ABSENCE MGMT.,INC.
MATRIX ABSENCE MANAGMENT, INC.
11/14/2017
MATRIX ABSENCE MANAGMENT, INC.
MATRIX ABSENCE MANAGEMENT, INC.
09/18/2018
© 2020 National Association of Insurance Commissioners. All rights reserved.
Ex. P, p. 18
https://sbs.naic.org/solar-external-lookup/lookup/company/summary/44200444?jurisdiction=OK
1/1
8/12/2020
Licensee Lookup Summary
Jurisdiction: Oklahoma
This document may serve in lieu of a Letter of Certification.
Licensee Demographics Name: MATRIX ABSENCE MANAGEMENT INC
NPN: 3486051
Domicile State: Arizona
Domicile Country: United States
Resident?: No
Business Address: PHOENIX, AZ 85029
License Quick View License Class
License Status
Status Date
Effective Date
Expiration Date
Adjuster
Active
03/31/2020
06/01/2020
05/31/2022
Phone, Email, Website Phone
Website No results found.
Type
Number
Type
Business Primary Phone
(800) 866-2301
Business Email
matrixlicensing@matrixcos.com
Fax Phone
(602) 866-9707
License Information License Type: Adjuster License Number: 3000296350
License Status: Active
Status Date: 03/31/2020
First Active Date: 05/04/2018
Effective Date: 06/01/2020
Expiration Date: 05/31/2022
Legacy License ID:
Line Of Authority Line Name
Qualification
Exam/Cert Date
Line Status
Status Date
Effective Date
Property
Reciprocity
School Code
05/04/2018
Approved
03/31/2020
05/04/2018
Casualty
Reciprocity
05/04/2018
Approved
03/31/2020
05/04/2018
Designated Responsible Licensed Producer Name
License #
NPN
License Class
License Status
Resident State
Start Date
STEVEN BETTS
3000310933
1231996
Adjuster
Active
Texas
06/19/2018
Relationships No results found.
Owners, Partners, Officers and Directors Name
Designation
Pct Owned
DONALD SHERMAN
DIRECTOR
No
05/04/2018
CHARLES DENARO
VP AND GENERAL COUNSEL
No
05/04/2018
GORDON SMITH
VP AND CIO
No
05/04/2018
GLENN PEIRCE
VP, FINANCE AND TREASURER
No
05/04/2018
KENNETH COPE
PRESIDENT AND CEO
No
05/04/2018
SUZANNE WILSON
VP AND SECRETARY
No
05/04/2018
CHRISTOPHER FAZZINI
DIRECTOR
No
05/04/2018
MICHAEL ASKINS
SVP FINANCE
No
05/04/2018
Delphi Financial Group, Inc.
Owner
Yes
05/04/2018
100
Owner
Status Date
Start Date
Branch Office Information No results found.
DBA/Trade Name No results found.
Appointments No results found.
© 2020 National Association of Insurance Commissioners. All rights reserved.
Ex. P, p. 19
https://sbs.naic.org/solar-external-lookup/lookup/licensee/summary/3000296350?jurisdiction=OK&entityType=BE&licenseType=ADJ
1/1
8/12/2020
Licensee Lookup Summary
Jurisdiction: Oregon
This document may serve in lieu of a Letter of Certification.
Licensee Demographics Name: MATRIX ABSENCE MANAGEMENT INC
NPN: 3486051
Domicile State: Arizona
Domicile Country: United States
Resident?: No
Business Address: PHOENIX, AZ 85029
License Quick View License Class
License Status
Status Date
Effective Date
Expiration Date
Adjuster
Active
11/15/2019
02/01/2020
01/31/2022
Third Party Administrator
Active
03/26/2020
05/01/2020
04/30/2022
Phone, Email, Website Phone
Website No results found.
Type
Number
Type
Business Primary Phone
(602) 866-2333
Business Email
matrixlicensing@matrixcos.com
Mailing Primary Phone
(602) 866-2333
Mailing Fax Phone
(602) 866-9707
Fax Phone
(602) 866-9707
License Information License Type: Third Party Administrator License Number: 100161250
License Status: Active
Status Date: 03/26/2020
First Active Date: 04/28/2000
Effective Date: 05/01/2020
Expiration Date: 04/30/2022
Legacy License ID: 811492
Line Of Authority No results found.
Designated Responsible Licensed Producer No results found.
Relationships No results found.
Business Entity Affiliations No results found.
Owners, Partners, Officers and Directors Name
Designation
Kenneth Cope Glenn Pierce
Pct Owned
Owner
Status Date
Start Date
President & CEO
No
08/16/2017
08/15/2017
VP Finance & Treasurer
No
08/16/2017
08/15/2017
Gordon P Smith
VP & CIO
No
08/16/2017
08/15/2017
Michael Askins
SVP Finance
No
08/16/2017
08/15/2017
Suzanne wilson
VP & Secretary
No
08/16/2017
08/15/2017
Charles T Denaro
VP & General Counsel
No
08/16/2017
08/15/2017
Branch Office Information No results found.
DBA/Trade Name No results found.
© 2020 National Association of Insurance Commissioners. All rights reserved.
Ex. P, p. 20
https://sbs.naic.org/solar-external-lookup/lookup/licensee/summary/100161250?jurisdiction=OR&entityType=BE&licenseType=TPA
1/1
8/12/2020
Licensee Lookup Summary
Jurisdiction: Rhode Island
Licensee Demographics Name: Matrix Absence Management, Inc
NPN: 3486051
Domicile State: Arizona
Domicile Country: United States
Resident?: No
Business Address: PHOENIX, AZ 85029
License Quick View License Class
License Status
Status Date
Effective Date
Expiration Date
Company/Independent Adjuster
Active
03/25/2020
06/01/2020
05/31/2022
Claim Adjusters
State No Longer Issues License Type
07/12/2007
09/01/2007
05/31/2009
Phone, Email, Website Phone
Website No results found.
Type
Number
Type
Fax Phone
(602) 866-9707
Business Email
matrixlicensing@matrixcos.com
Business Primary Phone
(800) 866-2301
License Information License Type: Company/Independent Adjuster License Number: 2030529
License Status: Active
Status Date: 03/25/2020
First Active Date: 05/26/2006
Effective Date: 06/01/2020
Expiration Date: 05/31/2022
Legacy License ID:
Line Of Authority Line Name
Qualification
School Code
Property/Casualty
Letter of Certification
Exam/Cert Date
Line Status
Status Date
Effective Date
03/29/2018
Approved
03/25/2020
03/29/2018
Designated Responsible Licensed Producer Name
License #
NPN
License Class
License Status
Resident State
Start Date
STEVEN BETTS
3000312243
1231996
Company/Independent Adjuster
Active
Texas
06/14/2018
Relationships No results found.
Business Entity Affiliations
NPN
Name
Related License #
Related License Type
Effective Date
1231996
STEVEN BETTS
3000312243
Company/Independent Adjuster
05/29/2018
17369578
SEAN MCGUIRE
3000383195
Company/Independent Adjuster
09/11/2018
Owners, Partners, Officers and Directors No results found.
Branch Office Information No results found.
DBA/Trade Name No results found.
© 2020 National Association of Insurance Commissioners. All rights reserved.
Ex. P, p. 21
https://sbs.naic.org/solar-external-lookup/lookup/licensee/summary/2030529?jurisdiction=RI&entityType=BE&licenseType=CAJ
1/1
8/12/2020
Licensee Lookup Summary
Jurisdiction: South Carolina
This document may serve in lieu of a Letter of Certification or Clearance
Licensee Demographics Name: MATRIX ABSENCE MANAGEMENT, INC.
NPN: 3486051
Domicile State: California
Domicile Country: United States
Resident?: No
Business Address: PHOENIX, AZ 85029
License Quick View License Class
License Status
Status Date
Effective Date
Expiration Date
Third Party Administrator
Active
02/06/2020
03/02/2020
03/01/2021
Phone, Email, Website Phone
Website No results found.
Type
Number
Type
Business Fax Phone
(317) 554-4375
Business Email
matrixlicensing@matrixcos.com
Business Primary Phone
(800) 866-2301 x54091
Business Toll Free Phone
(800) 980-1006
Fax Phone
(602) 866-9707
License Information License Type: Third Party Administrator License Number: 1900767098
License Status: Active
Status Date: 02/06/2020
First Active Date: 03/09/2011
Effective Date: 03/02/2020
Expiration Date: 03/01/2021
Legacy License ID: 166739
Line Of Authority No results found.
Designated Responsible Licensed Producer No results found.
Relationships No results found.
Owners, Partners, Officers and Directors Name
Designation
Gordon P Smith Glenn Pierce
Pct Owned
Owner
Status Date
Start Date
VP / Chief Information Officer
No
03/26/2019
03/26/2019
Vice President & Treasurer
No
03/26/2019
03/26/2019
Charles T Denaro
Vice President & General Counsel
No
03/26/2019
03/26/2019
Michael Askins
VP & CFO
No
03/26/2019
03/26/2019
Kenneth Cope
President and CEO
No
03/26/2019
03/26/2019
Suzanne Wilson
Vice President and Secretary
No
03/26/2019
03/26/2019
DBA/Trade Name No results found.
Appointments No results found.
© 2020 National Association of Insurance Commissioners. All rights reserved.
Ex. P, p. 22
https://sbs.naic.org/solar-external-lookup/lookup/licensee/summary/1900767098?jurisdiction=SC&entityType=BE&licenseType=TPA
1/1
8/12/2020
Licensee Lookup Summary
Jurisdiction: South Carolina
This document may serve in lieu of a Letter of Certification or Clearance
Licensee Demographics Name: MATRIX ABSENCE MANAGEMENT, INC.
NPN: 3486051
Domicile State: California
Domicile Country: United States
Resident?: No
Business Address: PHOENIX, AZ 85029
License Quick View License Class
License Status
Status Date
Effective Date
Expiration Date
Third Party Administrator
Active
02/06/2020
03/02/2020
03/01/2021
Phone, Email, Website Phone
Website No results found.
Type
Number
Type
Business Fax Phone
(317) 554-4375
Business Email
matrixlicensing@matrixcos.com
Business Primary Phone
(800) 866-2301 x54091
Business Toll Free Phone
(800) 980-1006
Fax Phone
(602) 866-9707
License Information License Type: Third Party Administrator License Number: 1900767098
License Status: Active
Status Date: 02/06/2020
First Active Date: 03/09/2011
Effective Date: 03/02/2020
Expiration Date: 03/01/2021
Legacy License ID: 166739
Line Of Authority No results found.
Designated Responsible Licensed Producer No results found.
Relationships No results found.
Owners, Partners, Officers and Directors Name
Designation
Gordon P Smith Glenn Pierce
Pct Owned
Owner
Status Date
Start Date
VP / Chief Information Officer
No
03/26/2019
03/26/2019
Vice President & Treasurer
No
03/26/2019
03/26/2019
Charles T Denaro
Vice President & General Counsel
No
03/26/2019
03/26/2019
Michael Askins
VP & CFO
No
03/26/2019
03/26/2019
Kenneth Cope
President and CEO
No
03/26/2019
03/26/2019
Suzanne Wilson
Vice President and Secretary
No
03/26/2019
03/26/2019
DBA/Trade Name No results found.
Appointments No results found.
© 2020 National Association of Insurance Commissioners. All rights reserved.
Ex. P, p. 23
https://sbs.naic.org/solar-external-lookup/lookup/licensee/summary/1900767098?jurisdiction=SC&entityType=BE&licenseType=TPA
1/1
8/12/2020
Licensee Lookup Summary
Jurisdiction: Wisconsin
This document may serve in lieu of a Letter of Certification.
Licensee Demographics Name: MATRIX ABSENCE MANAGEMENT INC
NPN: 3486051
Domicile State: Arizona
Domicile Country: United States
Resident?: No
Business Address: PHOENIX, AZ 85029
License Quick View License Class
License Status
Status Date
Effective Date
Expiration Date
Employee Benefit Plan Administrator
Active
07/14/2020
08/02/2020
08/01/2021
Phone, Email, Website Phone
Website No results found.
Type
Number
Type
Business Primary Phone
(800) 866-2301
Business Email
matrixlicensing@matrixcos.com
Fax Phone
(602) 866-9707
License Information License Type: Employee Benefit Plan Administrator License Number: 100198956
License Status: Active
Status Date: 07/14/2020
First Active Date: 07/30/2015
Effective Date: 08/02/2020
Expiration Date: 08/01/2021
Legacy License ID: 104498
Line Of Authority No results found.
Designated Responsible Licensed Producer No results found.
Relationships No results found.
Owners, Partners, Officers and Directors Name
Designation
Glenn Pierce
OPOD
Pct Owned
Owner No
Status Date
Start Date 07/24/2015
Kenneth Cope
OPOD
No
07/24/2015
Branch Office Information Branch Office Number 1
Name Wilson, Suzanne
Effective Status Date Active 07/24/2015
Address
Phone
2421 W Peoria Ave Ste 200 Phoenix, AZ 85029,2421 W Peoria Ave Ste 200
Business Fax Phone: (602) 866-9707 Business Primary Phone: (800) 8662301 Mailing Fax Phone: (602) 866-9707
Website
Business Email: suzanne.wilson@matrixcos.com Mailing Email: suzanne.wilson@matrixcos.com
Mailing Primary Phone: (800) 866-2301
DBA/Trade Name No results found.
Appointments No results found.
© 2020 National Association of Insurance Commissioners. All rights reserved.
Ex. P, p. 24
https://sbs.naic.org/solar-external-lookup/lookup/licensee/summary/100198956?jurisdiction=WI&entityType=BE&licenseType=EPA
1/1
8/12/2020
Company Lookup Summary
Jurisdiction: West Virginia
Demographics Company Name: Matrix Absence Management, Inc.
Short Name:
SBS Company Number: 109407710
NAIC CoCode:
FEIN: 77-0493584
Domicile Type: Foreign
State of Domicile: Delaware
Country of Domicile: United States
NAIC Group Number:
Organization Type: Corporation
Date of Incorporation: 05/11/2006
Merger Flag: No
DBA Name No results found.
Address Business Address
Mailing Address
Statutory Home Office Address
Main Administrative Office Address
2421 W PEORIA AVE STE 200 PHOENIX, AZ 85029
2421 W PEORIA AVE STE 200 PHOENIX, AZ 85029
2421 W PEORIA AVE STE 200 PHOENIX, AZ 85029
2421 W PEORIA AVE STE 200 PHOENIX, AZ 85029
United States
United States
United States
United States
Phone, Email, Website Phone
Type
Number
Business Primary Phone
(602) 866-2333
Mailing Primary Phone
(602) 866-2333
Statutory Home Office Primary Phone
(602) 866-2333
Main Admin Office Primary Phone
(602) 866-2333
Website
No results found.
No results found.
Company Type Company Type: Third Party Administrator (Non-Resident) Status: Active
Status Reason: Allowed to do Business
Status Date: 09/12/2019
Effective Date: 08/30/2019
Legacy State ID: 289914
Expiration Date: 10/31/2020
Issue Date: 05/06/2009
Approval Date: 05/06/2009
File Date: 05/06/2009
Articles of Incorporation Received: No
Article No:
COA Number:
Appointments No results found.
Line Of Business Line of Business
Citation Type
Effective Date
Third Party Administrator - Article 46
Third Party Administrator - Article 46
05/26/2009
Contact Contact Type
Preferred Name
Primary Home Contact
Complaint
Name
Phone
KENNETH COPE
KENNETH COPE
Address
Business Primary Phone: (408) 360-8370
Other
Fax Phone: (408) 360-9441
181 METRO DR STE 300
Business Primary Phone: (408) 360-8370
Other 181 METRO DR STE 300
Fax Phone: (408) 360-9441
SAN JOSE, CA United States County 95110
SAN JOSE, CA United States County 95110
Primary Mailing Contact
SILVIA LEE
Business Email: silvia.lee@matrixcos.com
Business Primary Phone: (602) 866-2333
Other 2421 W PEORIA AVE STE 200 PHOENIX, AZ United States County 85029
Company Merger No results found.
Name Change History Previous Name
New Name
Effective Date
MATRIX ABSENCE MANAGEMENT, INC. MATRIX ABSENCE MANAGEMENT, INC.
Matrix Absence Management, Inc.
10/06/2017
© 2020 National Association of Insurance Commissioners. All rights reserved.
Ex. P, p. 25
https://sbs.naic.org/solar-external-lookup/lookup/company/summary/109407710?jurisdiction=WV
1/1
8/12/2020
Company Lookup Summary
Jurisdiction: Alabama
Demographics Company Name: RELIANCE STANDARD LIFE INS CO
Short Name:
SBS Company Number: 74244928
NAIC CoCode: 68381
FEIN: 36-0883760
Domicile Type: Foreign
State of Domicile: Illinois
Country of Domicile: United States
NAIC Group Number: 3098 - Tokio Marine Holdings Inc GRP
Organization Type: NOT APPLICABLE
Date of Incorporation: 04/02/1907
Merger Flag: No
DBA Name No results found.
Address Business Address
Mailing Address
Statutory Home Office Address
Main Administrative Office Address
2001 Market Street Suite 1500
2001 Market Street Suite 1500
111 South Wacker Drive Suite 4400
2001 Market Street Suite 1500
Philadelphia, PA 19103 United States
Philadelphia, PA 19103 United States
Chicago, IL 60606-4410 United States
Philadelphia, PA 19103 United States
Phone, Email, Website Phone
Type
Number
Business Primary Phone
(800) 351-7500
Business Toll Free Phone
(267) 256-3500
Mailing Primary Phone
(800) 351-7500
Main Admin Office Primary Phone
(800) 351-7500
Main Admin Office Toll Free Phone
(267) 256-3664
Website
No results found.
No results found.
Company Type Company Type: Life & Health Status: Active
Status Reason:
Status Date: 05/21/1968
Effective Date: 05/21/1968
Legacy State ID: 218250
Expiration Date:
Issue Date: 05/21/1968
Approval Date:
File Date:
Articles of Incorporation Received: No
Article No:
COA Number:
Appointments Show 10
Showing 1 to 10 of 1201 entries
entries
Filter
Licensee Name
License Number
NPN
License Type
Line of Authority
Appointment Date
Effective Date
Expiration Date
NICOLE MCCLENNY
3000248474
18714838
Insurance Producer
Life
03/04/2018
01/01/2020
12/31/2020
MARK CAGLE
297511
8271158
Insurance Producer
Life
03/11/2017
01/01/2020
12/31/2020
MELISSA TYLER
294866
9890375
Insurance Producer
Life
10/22/2014
01/01/2020
12/31/2020
HUDGENS INSURANCE INC
79444
5852438
Insurance Producer
Life
05/12/2010
01/01/2020
12/31/2020
COUSINS INSURANCE AGENCY, INC.
79940
5853386
Insurance Producer
Life
05/01/2013
01/01/2020
12/31/2020
LAWRENCE FRANKLIN
305217
10800768
Insurance Producer
Life
03/01/2014
01/01/2020
12/31/2020
JAMES HALE
302544
10603189
Insurance Producer
Life
03/18/2014
01/01/2020
12/31/2020
COBBS-ALLEN & HALL, INC.
79319
2110564
Insurance Producer
Life
05/08/2010
01/01/2020
12/31/2020
MCBRIDE BENEFIT SOLUTIONS INC
79345
5852259
Insurance Producer
Life
05/11/2010
01/01/2020
12/31/2020
GLS & ASSOCIATES INC
80136
4669419
Insurance Producer
Life
05/11/2010
01/01/2020
12/31/2020
First
Previous
1
2
3
Next
Last
Line Of Business Line of Business
Citation Type
Effective Date
01: Life, Disability and Annuities
Default Section Code Alabama
05/21/1968
Contact Contact Type President
Preferred Name
Name
Christopher Fazzini
Phone Business Primary Phone: (800) 351-7500 Business Toll Free Phone: (267) 256-3664
Agent for Service of Process
C T Corporation System
Address Other 2001 Market Street Suite 1500 Philadelphia, PA United States County 19103 Other 2 North Jackson Street Suite 605 Montgomery, AL United States County 36104
© 2020 National Association of Insurance Commissioners. All rights reserved.
https://sbs.naic.org/solar-external-lookup/lookup/company/summary/74244928?jurisdiction=AL
Ex. Q, p. 1
1/2
8/12/2020
Company Lookup Summary
Jurisdiction: Arkansas
Demographics Company Name: RELIANCE STANDARD LIFE INSURANCE COMPANY
Short Name:
SBS Company Number: 64232347
NAIC CoCode: 68381
FEIN: 36-0883760
Domicile Type: Foreign
State of Domicile: Illinois
Country of Domicile: United States
NAIC Group Number: 3098 - Tokio Marine Holdings Inc GRP
Organization Type: Not Applicable
Date of Incorporation:
Merger Flag: No
DBA Name No results found.
Address Business Address
Mailing Address
Statutory Home Office Address
Main Administrative Office Address
NA NA, UN 99999
2001 Market Street, Suite 1500 Philadelphia, PA 19103
1100 East Woodfield Road, Two Woodfield Lake, Suit
2001 Market Street, Suite 1500 Philadelphia, UN 19103
United States
United States
115 South LaSalle Street Schaumburg, IL 60173 United States
United States
Phone, Email, Website Phone
Website
Type
Number
Type
Type
Website
Other Phone
(267) 256-3664
Statutory Home Office Email
david.rzaca@rsli.com
Website
www.reliancestandard.com
Mailing Primary Phone
(267) 256-3500
paul.van.haren@rsli.com
Mailing Toll Free Phone
(800) 351-7500
Statutory Home Office Primary Phone
(267) 256-3500
Statutory Home Office Toll Free Phone
(800) 351-7500
Company Type Company Type: Life and Disability Status: Active
Status Reason:
Status Date: 08/25/1966
Effective Date: 08/25/1966
Legacy State ID: 335284
Expiration Date:
Issue Date: 08/25/1966
Approval Date: 08/25/1966
File Date:
Articles of Incorporation Received: No
Article No:
COA Number: 1192
Appointments Show 10
Showing 1 to 10 of 475 entries
entries
Licensee Name
License Number
NPN
License Type
EMPLOYEE BENEFIT SYSTEMS INC OF TEXAS
100115054
1931173
National Insurance Benefit Coordinators, Inc
100102765
8701634
ROBERT MILLER
578819
Demetria Ellis TODD EATON
Line of Authority
Filter
Appointment Date
Effective Date
Expiration Date
Insurance Producer
09/27/2019
06/26/2020
06/30/2021
Insurance Producer
02/04/2020
06/26/2020
06/30/2021
578819
Insurance Producer
02/04/2020
06/26/2020
06/30/2021
16877116
16877116
Insurance Producer
08/11/2014
06/26/2020
06/30/2021
1677760
1677760
Insurance Producer
02/01/2020
06/26/2020
06/30/2021
ANDREA GIFFORD
18421540
18421540
Insurance Producer
01/14/2020
06/26/2020
06/30/2021
Michael Hendrickson
16283915
16283915
Insurance Producer
02/24/2020
06/26/2020
06/30/2021
LARRY ROOT
1217350
1217350
Insurance Producer
10/02/2019
06/26/2020
06/30/2021
K. F. Agency, Inc.
100106088
757661
Insurance Producer
02/18/2020
06/26/2020
06/30/2021
SCOTT ALLISON
1672249
1672249
Insurance Producer
06/05/2006
06/26/2020
06/30/2021
First
Previous
1
2
3
Next
Last
Line Of Business Line of Business
Citation Type
Effective Date
Accident and Health
Accident and Health 23-62-103
08/25/1966
Life
Life 23-62-102
08/25/1966
Variable Products
Variable Products 23-81-401
08/25/1966
Contact Contact Type Complaints
Preferred Name
Name Charles Denaro
Phone
Business Email: charles.denaro@rsli.com
Business Primary Phone: (267) 256-3810 Fax Phone: (267) 256-0650
Service of Process
C T Corporation System
Business Primary Phone: (501) 244-9034 Fax Phone: (501) 376-8433
© 2020 National Association of Insurance Commissioners. All rights reserved.
https://sbs.naic.org/solar-external-lookup/lookup/company/summary/64232347?jurisdiction=AR
Ex. Q, p. 2
Address Other 2001 Market Street, Suite 1500 PHILADELPHIA, PA United States County 19046 Other 124 West Capitol Avenue Suite 1900 Litte Rock, AR United States County 722013726
1/2
8/12/2020
Company Lookup Summary
Jurisdiction: Arizona
Demographics Company Name: RELIANCE STANDARD LIFE INSURANCE COMPANY
Short Name: RELIANCE S
SBS Company Number: 49209885
NAIC CoCode: 68381
FEIN: 36-0883760
Domicile Type: Foreign
State of Domicile: Illinois
Country of Domicile: United States
NAIC Group Number: 3098 - Tokio Marine Holdings Inc GRP
Organization Type: STOCK CORPORATION
Date of Incorporation: 04/15/1907
Merger Flag: No
DBA Name No results found.
Address Mailing Address
Statutory Home Office Address
2001 Market Street, Suite 1500 Philadelphia, PA 19103
1100 East Woodfield Road, Two Woodfield Lake, Suit
United States
Schaumburg, IL 60173 United States
Phone, Email, Website Phone
Website
Type
Number
Type
Type
Website
Other Phone
(267) 256-3664
paul.van.haren@rsli.com
Website
www.reliancestandard.com
Other Phone
(267) 256-3500
Statutory Home Office Primary Phone
(800) 351-7500
Main Admin Office Primary Phone
(800) 351-7500
Company Type Company Type: Life & Disability Insurer Status: Active
Status Reason:
Status Date: 08/26/2016
Effective Date: 04/15/1907
Legacy State ID: 68381
Expiration Date:
Issue Date: 04/15/1907
Approval Date: 04/15/1907
File Date: 04/15/1907
Articles of Incorporation Received: No
Article No:
COA Number:
Line Of Business Line of Business
Citation Type
Effective Date
Disability
02/14/1912
Life
02/14/1912
Contact Preferred Contact Type MARKET CONDUCT ANNUAL STATEMENT
Name
Address Name
Janet Bowlby
Business Email:
CONTACT STATUTORY AGENT
janet.bowlby@rsli.com Director of Insurance
Phone Business Primary Phone: (267) 2563799 Business Primary Phone: (602) 3643100
Other Attention: Director As Statutory Agent Arizona Department of Insurance 100 N 15TH AVE STE 261 PHOENIX, AZ United States County 85007-2630
ELECTRONIC CONTACT PERSON AND ADDRESS
Paul Van Haren
Business Primary Phone: 267-2563664
MARKET CONDUCT CONTACT AND ADDRESS
Charles Denaro
Business Email: charles.denaro@rsli.com
GOVERNMENT RELATIONS CONTACT AND
Charles Denaro
ADDRESS
PRESIDENT
POLICYOWNER RELATIONS CONTACT AND ADDRESS
Business Email: charles.denaro@rsli.com
CHRISTOPHER FAZZINI
Charles Denaro
Business Primary Phone: 267-2563810
Business Primary Phone: 267-2563810
Business Primary Phone: (800) 3517500
Business Email: charles.denaro@rsli.com
Business Primary Phone: 267-2563810
Other 2001 Market Street, Suite 1500 Philadelphia, PA United States County 19103 Other 2001 Market Street, Suite 1500 Philadelphia, PA United States County 19103 Other 2001 Market Street, Suite 1500 Philadelphia, PA United States County 19103 Other 2001 MARKET STREET, SUITE 1500 PHILADELPHIA, PA United States County 19103 Other 2001 Market Street, Suite 1500 Philadelphia, PA United States County 19103
© 2020 National Association of Insurance Commissioners. All rights reserved.
https://sbs.naic.org/solar-external-lookup/lookup/company/summary/49209885?jurisdiction=AZ
Ex. Q, p. 3
1/2
8/12/2020
Company Lookup Summary Preferred
Contact Type
SECRETARY
Name
Address Name
CHARLES DENARO
Phone
Business Primary Phone: (800) 3517500
Other 2001 MARKET STREET, SUITE 1500 PHILADELPHIA, PA United States County 19103
CURRENT FINANCIAL STATEMENT CONTACT
Paul Van Haren
Business Email: paul.van.haren@rsli.com
Business Fax Phone: 267-256-3522
Other
Business Primary Phone: 267-256-
2001 Market Street, Suite 1500 Philadelphia, PA
3664
United States County 19103
Branch Offices Company Merger No results found.
Name Change History No results found.
© 2020 National Association of Insurance Commissioners. All rights reserved.
https://sbs.naic.org/solar-external-lookup/lookup/company/summary/49209885?jurisdiction=AZ
Ex. Q, p. 4
2/2
8/12/2020
Company Lookup Summary
Jurisdiction: Delaware
Demographics Company Name: RELIANCE STANDARD LIFE INSURANCE COMPANY
Short Name:
SBS Company Number: 9158804
NAIC CoCode: 68381
FEIN: 36-0883760
Domicile Type: Foreign
State of Domicile: Illinois
Country of Domicile: United States
NAIC Group Number: 3098 - Tokio Marine Holdings Inc GRP
Organization Type: Stock
Date of Incorporation: 04/12/1907
Merger Flag: No
DBA Name No results found.
Address Business Address
Mailing Address
Statutory Home Office Address
Main Administrative Office Address
2001 Market Street, Suite 1500 Philadelphia, PA 19103
2001 Market Street, Suite 1500 Philadelphia, PA 19103
111 South Wacker Drive, Suite 4400 Chicago, IL 60606-4410
2001 Market Street, Suite 1500 Philadelphia, PA 19103
United States
United States
United States
United States
Phone, Email, Website Phone
Website
No results found.
Type
Number
Type
Website
Business Primary Phone
(267) 256-3500
Business URL
www.rsli.com
Business Fax Phone
(267) 256-3522
Business URL
www.rsli.com
Business Secondary Phone
(800) 351-7500
Business URL
www.rsli.com
Mailing Primary Phone
(267) 256-3500
Business URL
www.rsli.com
Mailing Fax Phone
(267) 256-3522
Mailing Secondary Phone
(800) 351-7500
Statutory Home Office Primary Phone
(800) 351-7500
Main Admin Office Primary Phone
(267) 256-3500
Main Admin Office Fax Phone
(267) 256-3522
Main Admin Office Secondary Phone
(800) 351-7500
Company Type Company Type: Life And Health Status: Active
Status Reason:
Status Date: 06/09/1965
Effective Date: 06/09/1965
Legacy State ID: 10000717
Expiration Date:
Issue Date: 06/09/1965
Approval Date: 06/09/1965
File Date: 06/09/1965
Articles of Incorporation Received: No
Article No: 3
COA Number: 1532P
Appointments Show 10
Showing 1 to 10 of 203 entries
entries
Line of Authority
Filter
Licensee Name
License Number
NPN
License Type
Appointment Date
Effective Date
MICHAEL BLANK
116307
1002993
Insurance Producer
11/20/2003
11/20/2003
ROBERT SONCHEN
124883
7021163
Insurance Producer
06/26/2002
06/26/2002
CHRISTINE BALON
1008155
1359851
Insurance Producer
03/12/2013
03/12/2013
SCOTT DAVENPORT
1024870
1979985
Insurance Producer
08/14/2012
08/14/2012
LEON LEVY
112208
617511
Insurance Producer
09/08/2008
09/08/2008
LORETTA DIBATTISTA
163174
7459581
Insurance Producer
05/21/2009
05/21/2009
JEROME POOLE
123389
632726
Insurance Producer
06/20/2011
06/20/2011
MICHAEL BUCHLER
124315
1005452
Insurance Producer
08/18/1998
08/18/1998
DANIEL BATTY
119750
1996732
Insurance Producer
06/02/2008
06/02/2008
THOMAS MAYER
1017423
3150271
Insurance Producer
09/24/2007
09/24/2007 First
Previous
1
Expiration Date
2
3
Next
Last
Line Of Business Line of Business
Citation Type
Effective Date
LIFE
Section 902 Life
06/09/1965
HEALTH
Section 903 Health
06/09/1965
VARIABLE ANNUITY
Regulation 1 Variable Annuities
12/06/1990
VARIABLE LIFE
Regulation 44 Variable Life
12/06/1990
Contact Preferred Contact Type Regulatory Compliance/Government Relations
Name
Address Name
Charles T. Denaro
Phone Business Primary Phone: (800) 929-0538
© 2020 National Association of Insurance Commissioners. All rights reserved.
https://sbs.naic.org/solar-external-lookup/lookup/company/summary/9158804?jurisdiction=DE
Ex. Q, p. 5
Other 2001 Market Street #1500 Philadelphia, PA United States County
1/2
8/12/2020
Company Lookup Summary Preferred
Contact Type
Name
President/CEO
Name
Phone
Lawrence
Business Primary Phone: (267) 256-3500
Other
Daurelle
Business Secondary Phone: (800) 351-
2001 Market Street, Suite 1500 Philadelphia, PA
7500 Fax Phone: (267) 256-3522 Vice President
United States County Address 19103
Thomas Lutter
Email: tom.lutter@rsli.com
Business Primary Phone: (267) 256-3582
United States County 19103 Other 2001 Market Streeet Suite 1500 Philadelphia, PA United States County 19103
Complaints -Compliance
Gail Murphy
Business Primary Phone: (800) 351-7500
Other 2001 Market Street, Ste. 1500 Philadelphia, PA United States County 191037090
Vice President
John Albanese
Email: john.albanese@rsli.com
Treasurer
Thomas Burghart
Business Primary Phone: (267) 570-8873
Other 2001 Market Street Suite 1500 Philadelphia, PA United States County 19103
Business Primary Phone: (267) 256-3500
Other 2001 Market Street, Suite 1500 Philadelphia, PA United States County 19103
Business Secondary Phone: (800) 3517500 Fax Phone: (267) 256-3522 Consumer Complaints Contact
CHARLES DENARO
Business Email: charles.denaro@rsli.com
Business Primary Phone: (267) 256-3810 Fax Phone: (267) 256-0650
Other 2001 MARKET ST STE 1500 PHILADELPHIA, VA United States County 19103
Branch Offices Company Merger No results found.
Name Change History Previous Name
New Name
Effective Date
RELIANCE STANDARD LIFE INSURANCE COMPANY
© 2020 National Association of Insurance Commissioners. All rights reserved.
https://sbs.naic.org/solar-external-lookup/lookup/company/summary/9158804?jurisdiction=DE
Ex. Q, p. 6
2/2
8/12/2020
Company Lookup Summary
Jurisdiction: Illinois
Demographics Company Name: RELIANCE STANDARD LIFE INSURANCE COMPANY
Short Name:
SBS Company Number: 14161386
NAIC CoCode: 68381
FEIN: 36-0883760
Domicile Type: Domestic
State of Domicile: Illinois
Country of Domicile: United States
NAIC Group Number: 3098 - Tokio Marine Holdings Inc GRP
Organization Type: Mutual
Date of Incorporation: 04/12/1907
Merger Flag: No
DBA Name No results found.
Address Business Address
Mailing Address
Statutory Home Office Address
Main Administrative Office Address
TWO COMMERCE SQUARE 2001 MARKET ST STE 1500
TWO COMMERCE SQUARE 2001 MARKET ST STE 1500
1100 EAST WOODFIELD ROAD TWO WOODFIELD LAKE STE 437
TWO COMMERCE SQUARE 2001 MARKET ST STE 1500
PHILADELPHIA, PA 19103 United States
PHILADELPHIA, PA 19103 United States
SCHAUMBURG, IL 60173 United States
PHILADELPHIA, PA 19103 United States
Phone, Email, Website Phone
Type
Number
Business Primary Phone
(267) 256-3500
Mailing Primary Phone
(267) 256-3500
Statutory Home Office Primary Phone
(267) 256-3500
Main Admin Office Primary Phone
(267) 256-3500
Website
No results found.
No results found.
Company Type Company Type: LIFE, ACCIDENT & HEALTH Status: Active
Status Reason:
Status Date: 04/12/1907
Effective Date: 04/12/1907
Legacy State ID: 501985
Expiration Date:
Issue Date: 04/12/1907
Approval Date:
File Date:
Articles of Incorporation Received: No
Article No:
COA Number:
Appointments No results found.
Line Of Business No results found.
Contact No results found.
Branch Offices Company Merger No results found.
Name Change History No results found.
© 2020 National Association of Insurance Commissioners. All rights reserved.
https://sbs.naic.org/solar-external-lookup/lookup/company/summary/14161386?jurisdiction=IL
Ex. Q, p. 7
1/1
8/12/2020
Company Lookup Summary
Jurisdiction: Missouri
Demographics Company Name: RELIANCE STANDARD LIFE INSURANCE COMPANY
Short Name:
SBS Company Number: 104344446
NAIC CoCode: 68381
FEIN: 36-0883760
Domicile Type: Foreign
State of Domicile: Illinois
Country of Domicile: United States
NAIC Group Number: 3098 - Tokio Marine Holdings Inc GRP
Organization Type: Corporation
Date of Incorporation: 04/02/1907
Merger Flag: Yes
DBA Name No results found.
Address Business Address
Mailing Address
Statutory Home Office Address
Main Administrative Office Address
115 S LASALLE ST CHICAGO, IL 60603
2001 Market Street, Suite 1500 Philadelphia, PA 19103
1100 East Woodfield Road, Two Woodfield Lake, Suit
2001 Market Street, Suite 1500 Philadelphia, PA 19103
United States
United States
Schaumburg, IL 60173 United States
United States
Phone, Email, Website Phone
Website
Type
Number
Type
Type
Website
Other Phone
(267) 256-3664
paul.van.haren@rsli.com
Business URL
WWW.RSLI.COM
Business Primary Phone
(267) 256-3500
Website
www.reliancestandard.com
Business Fax Phone
(267) 256-3522
Business Toll Free Phone
(800) 351-7500
Mailing Primary Phone
(267) 256-3500
Statutory Home Office Primary Phone
(267) 256-3500
Statutory Home Office Fax Phone
(267) 256-3522
Main Admin Office Primary Phone
(267) 256-3500
Main Admin Office Fax Phone
(267) 256-3522
Company Type Company Type: Life and Health (Ch 376 & 377, RSMo) Status: Active
Status Reason:
Status Date: 07/12/1913
Effective Date: 07/12/1913
Legacy State ID: 421592
Expiration Date: 07/01/2021
Issue Date: 07/12/1913
Approval Date:
File Date:
Articles of Incorporation Received: No
Article No:
COA Number:
Line Of Business Line of Business
Citation Type
Effective Date
A1 - Life, annuities and endowments (376.010, RSMo)
A1 - Life, annuities and endowments (376.010 RSMo)
07/12/1913
A2 - Accident and Health (376.010, RSMo)
A2 - Accident and Health (76.010, RSMo)
07/12/1913
A3 - Variable contracts (376.309, RSMo)
A3 - Variable Contracts (376.09, RSMo)
07/12/1913
Contact No results found.
Company Merger SBS Company NAIC Number CoCode Non-Surviving Company
Non-Surviving Company Type
104341967
Life and Health (Ch 376 N & 377, RSMo)
ILLINOIS BANKERS LIFE ASSURANCE COMPANY
Terminated Appointments
Transferred Appointments
Merger Date
N
10/26/1951 Effective 10/26/1951 Central Standard Life Insurance Company reinsured the business of Illinois Bankers Life Assurance Company.
Comments
Companies Absorbed
Name Change History Previous Name
New Name
Effective Date
CENTRAL LIFE INSURANCE CO OF ILLINOIS
07/12/1913
CENTRAL LIFE INSURANCE CO OF ILLINOIS
RELIANCE STANDARD LIFE INSURANCE COMPANY
12/30/1965
RELIANCE STANDARD LIFE INSURANCE COMPANY
CENTRAL STANDARD LIFE INSURANCE COMPANY
05/10/1951
CENTRAL STANDARD LIFE INSURANCE COMPANY
RELIANCE STANDARD LIFE INSURANCE COMPANY
12/30/1965
Info
x
No Results Found. © 2020 National Association of Insurance Commissioners. All rights reserved.
Ex. Q, p. 8
https://sbs.naic.org/solar-external-lookup/lookup/company/summary/104344446?jurisdiction=MO
1/1
8/12/2020
Company Lookup Summary
Jurisdiction: Montana
Demographics Company Name: RELIANCE STANDARD LIFE INSURANCE COMPANY
Short Name:
SBS Company Number: 29178755
NAIC CoCode: 68381
FEIN: 36-0883760
Domicile Type: Foreign
State of Domicile: Illinois
Country of Domicile: United States
NAIC Group Number: 3098 - Tokio Marine Holdings Inc GRP
Organization Type: Other
Date of Incorporation: 04/02/1907
Merger Flag: No
DBA Name No results found.
Address Business Address
Mailing Address
Statutory Home Office Address
Main Administrative Office Address
NA NA, IL 99999
2001 MARKET ST STE 1500 PHILADELPHIA, PA 19103
1100 E WOODFIELD RD TWO WOODFIELD LAKE
2001 MARKET ST STE 1500 PHILADELPHIA, PA 19103
United States
United States
SCHAUMBURG, IL 60173 United States
United States
Phone, Email, Website Phone
Website
Type
Number
Type
Type
Website
Fax Phone
(267) 256-3522
Business Email
PAUL.VAN,HAREN@RSLI.COM
Business URL
WWW.RELIANCESTANDARD.COM
Toll Free Phone
(800) 351-7500
Main Admin Office Primary Phone
(267) 256-3500
Company Type Company Type: Life and Disability Insurer Status: Active
Status Reason:
Status Date: 04/12/1926
Effective Date: 04/12/1926
Legacy State ID: 375278
Expiration Date:
Issue Date: 04/12/1926
Approval Date:
File Date:
Articles of Incorporation Received: No
Article No:
COA Number:
Appointments Show 10
Showing 1 to 10 of 238 entries
entries
Filter
Licensee Name
License Number
NPN
License Type
Line of Authority
Appointment Date
Effective Date
DAVID ALLEN
65649
6958107
Insurance Producer
Disability (Health)
05/19/2014
05/19/2014
DEAN VANDERSNICK
53837
659188
Insurance Producer
Disability (Health)
06/14/2008
06/14/2008
DIGITAL INSURANCE LLC
970199
3698440
Insurance Producer
Disability (Health)
04/23/2015
04/23/2015
ART JETTER & COMPANY
970184
1005360
Insurance Producer
Disability (Health)
01/03/2014
01/03/2014
ARTHUR JETTER
65601
228714
Insurance Producer
Disability (Health)
01/03/2014
01/03/2014
RONALD LANE
17047
237250
Insurance Producer
Disability (Health)
10/08/1997
10/08/1997
GREGORY LOVEGROVE
52219
3380600
Insurance Producer
Disability (Health)
12/02/2014
12/02/2014
ELIZABETH FORD
990196
1286617
Insurance Producer
Disability (Health)
03/03/2015
03/03/2015
EQUINOX MANAGEMENT GROUP INC
911161
1992819
Insurance Producer
Disability (Health)
09/11/2001
09/11/2001
AMANDA AHLQUIST
744264
16223759
Insurance Producer
Disability (Health)
08/14/2014
08/14/2014 First
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1
2
Expiration Date
3
Next
Last
Line Of Business Line of Business
Citation Type
Effective Date
Disability
Disability- 33-1-207
04/12/1926
Life
Life- 33-1-208
04/12/1926
Credit Disability
Credit Disability- 33-1-218
04/12/1926
Credit Life
Credit Life- 33-1-218
04/12/1926
Contact Contact Type
Preferred Name
Complaints
Name Charles T. Denaro
Phone
Business Email: charles.denaro@rsli.com
Business Primary Phone: (267) 256-3810 Fax Phone: (267) 256-0650
Address Other 2001 Market Street, Suite 1500 Philadelphia, PA United States County 19046
Branch Offices © 2020 National Association of Insurance Commissioners. All rights reserved.
Ex. Q, p. 9
https://sbs.naic.org/solar-external-lookup/lookup/company/summary/29178755?jurisdiction=MT
1/2
8/12/2020
Company Lookup Summary
Company Merger No results found.
Name Change History Previous Name
New Name
Effective Date
CENTRAL LIFE INSURANCE COMPANY OF ILLINOIS
04/12/1926
CENTRAL LIFE INSURANCE COMPANY OF ILLINOIS
CENTRAL STANDARD LIFE INSURANCE COMPANY
04/30/1951
CENTRAL STANDARD LIFE INSURANCE COMPANY
RELIANCE STANDARD LIFE INSURANCE COMPANY
08/09/1965
© 2020 National Association of Insurance Commissioners. All rights reserved.
Ex. Q, p. 10
https://sbs.naic.org/solar-external-lookup/lookup/company/summary/29178755?jurisdiction=MT
2/2
8/12/2020
Company Lookup Summary
Jurisdiction: North Dakota
Demographics Company Name: Reliance Standard Life Insurance Company
Short Name:
SBS Company Number: 19163153
NAIC CoCode: 68381
FEIN: 36-0883760
Domicile Type: Foreign
State of Domicile: Illinois
Country of Domicile: United States
NAIC Group Number: 3098 - Tokio Marine Holdings Inc GRP
Organization Type: Unknown
Date of Incorporation: 04/02/1907
Merger Flag: No
DBA Name No results found.
Address Business Address
Mailing Address
Statutory Home Office Address
Main Administrative Office Address
115 S Lasalle Street Chicago, IL 60603
2001 Market Street, Suite 1500 Philadelphia, PA 19103
1100 East Woodfield Road, Two Woodfield Lake, Suit
2001 Market Street, Suite 1500 Philadelphia, PA 19103
United States
United States
Schaumburg, IL 60173 United States
United States
Phone, Email, Website Phone
Website
Type
Number
Type
Type
Website
Other Phone
(267) 256-3664
Mailing Email
charles.denaro@rsli.com
Website
www.reliancestandard.com
Other Phone
(267) 256-3500
paul.van.haren@rsli.com
Business Fax Phone
(267) 256-0650
Mailing Primary Phone
(800) 351-7500
Mailing Fax Phone
(267) 256-0650
Mailing Secondary Phone
(267) 256-3810
Company Type Company Type: Life Status: Active
Status Reason:
Status Date: 02/01/1997
Effective Date: 02/01/1997
Legacy State ID: 504879
Expiration Date:
Issue Date: 04/01/1925
Approval Date:
File Date:
Articles of Incorporation Received: No
Article No:
COA Number:
Appointments Show 10
Showing 1 to 10 of 197 entries
entries
Line of Authority
Filter
Licensee Name
License Number
NPN
License Type
Appointment Date
Effective Date
Expiration Date
RANDALL QUALE
658972
658972
Insurance Producer
02/26/2020
02/26/2020
04/30/2021
THOMAS MAYER
3150271
3150271
Insurance Producer
05/01/2013
04/20/2020
04/30/2021
TODD OLSON
2781471
2781471
Insurance Producer
12/23/2015
04/20/2020
04/30/2021
CLAUDIA MACKENZIE
5739272
5739272
Insurance Producer
05/01/2013
04/20/2020
04/30/2021
RUSSELL ARMAN
658261
658261
Insurance Producer
05/01/2013
04/20/2020
04/30/2021
MICHAEL BORMANN
16477009
16477009
Insurance Producer
05/01/2013
04/20/2020
04/30/2021
BRADLEY BAKKEN
661319
661319
Insurance Producer
10/21/2017
04/20/2020
04/30/2021
MELINDA KEMPEL
5740465
5740465
Insurance Producer
01/30/2018
04/20/2020
04/30/2021
RANDY SCHOBINGER
14603315
14603315
Insurance Producer
03/05/2018
04/20/2020
04/30/2021
JAMES DUNKEL
659215
659215
Insurance Producer
02/26/2018
04/20/2020
04/30/2021
First
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1
2
3
Next
Last
Line Of Business Line of Business
Citation Type
Effective Date
Accident & Health
Accident & Health
02/01/1997
Variable Life & Annuity
Variable Life & Annuity
02/01/1997
Life & Annuity
Life & Annuity
02/01/1997
Contact Contact Type
Preferred Name
Name
Appt Renewal
Marge Thomas
Phone
Address Other Two Commerce Square 2001 Market St Ste 1500 Philadelphia, PA United States County 19103
Branch Offices
© 2020 National Association of Insurance Commissioners. All rights reserved.
Ex. Q, p. 11
https://sbs.naic.org/solar-external-lookup/lookup/company/summary/19163153?jurisdiction=ND
1/2
8/12/2020
Company Lookup Summary
Company Merger No results found.
Name Change History Previous Name
New Name
Effective Date
Reliance Standard Life Insurance Company
02/01/1997
© 2020 National Association of Insurance Commissioners. All rights reserved.
Ex. Q, p. 12
https://sbs.naic.org/solar-external-lookup/lookup/company/summary/19163153?jurisdiction=ND
2/2
8/12/2020
Company Lookup Summary
Jurisdiction: Nebraska
Demographics Company Name: RELIANCE STANDARD LIFE INSURANCE COMPANY
Short Name:
SBS Company Number: 59224409
NAIC CoCode: 68381
FEIN: 36-0883760
Domicile Type: Foreign
State of Domicile: Illinois
Country of Domicile: United States
NAIC Group Number: 3098 - Tokio Marine Holdings Inc GRP
Organization Type: Other
Date of Incorporation: 01/01/1907
Merger Flag: No
DBA Name No results found.
Address Business Address
Mailing Address
Statutory Home Office Address
Main Administrative Office Address
Not Available Not Available, UN 99999
2001 Market Street, Suite 1500 Philadelphia, PA 19103
1100 East Woodfield Road, Two Woodfield Lake, Suit
2001 Market Street, Suite 1500 Philadelphia, PA 19103
United States
United States
Schaumburg, IL 60173 United States
United States
Phone, Email, Website Phone
Website
Type
Number
Type
Type
Website
Other Phone
(267) 256-3664
paul.van.haren@rsli.com
Website
www.reliancestandard.com
Other Phone
(267) 256-3500
Mailing Primary Phone
(800) 351-7500
Mailing Fax Phone
(267) 256-0650
Company Type Company Type: Life and Health Status: Active
Status Reason:
Status Date: 12/12/1990
Effective Date: 05/01/2020
Legacy State ID: 149095
Expiration Date: 04/30/2021
Issue Date: 10/19/1919
Approval Date:
File Date:
Articles of Incorporation Received: No
Article No:
COA Number:
Appointments Show 10
Showing 1 to 10 of 260 entries
entries
Licensee Name
License Number
NPN
License Type
TIMOTHY MOLLAK
17787874
17787874
JACK STRUYK
228305
228305
DAVID FIELD
2953806
2953806
SCOTT FREESE
890175
BRIAN URBAN
3195219
NICHOLAS WESTBYE
Line of Authority
Filter
Appointment Date
Effective Date
Expiration Date
Insurance Producer
03/22/2019
07/27/2020
07/31/2021
Insurance Producer
11/02/2017
07/27/2020
07/31/2021
Insurance Producer
06/17/2008
07/27/2020
07/31/2021
890175
Insurance Producer
05/01/1996
07/27/2020
07/31/2021
3195219
Insurance Producer
12/14/2017
07/27/2020
07/31/2021
8999015
8999015
Insurance Producer
07/15/2011
07/27/2020
07/31/2021
GREGORY POWELL
3380363
3380363
Insurance Producer
03/27/2018
07/27/2020
07/31/2021
THOMAS LAUGHLIN
228184
228184
Insurance Producer
12/18/2014
07/27/2020
07/31/2021
RITCHIE NELSON
133844
133844
Insurance Producer
11/20/1995
07/27/2020
07/31/2021
KURT KECHELY
228893
228893
Insurance Producer
10/15/2002
07/27/2020
07/31/2021
First
Previous
1
2
3
Next
Last
Line Of Business Line of Business
Citation Type
Effective Date
01 Life Insurance
Life Insurance 44-201
12/12/1990
02 Variable Life Insurance
Variable Life Insurance 44-201
12/12/1990
03 Variable Annuities
Variable Annuities 44-201
12/12/1990
04 Sickness and Accident Insurance
Sickness and Accident Insurance 44-201
12/12/1990
Contact Contact Type Agent for Service of Process
Preferred Name
Name
CHARLES DENARO
Phone Business Primary Phone: (800) 351-7500
Address Other TWO COMMERCE SQUARE 2001 MARKET STREET, SUITE 1500 PHILADELPHIA, PA United States County 19103
Info
Branch Offices
x
No Results Found. © 2020 National Association of Insurance Commissioners. All rights reserved.
Ex. Q, p. 13
https://sbs.naic.org/solar-external-lookup/lookup/company/summary/59224409?jurisdiction=NE
1/2
8/12/2020
Company Lookup Summary
Company Merger No results found.
Name Change History Previous Name
New Name
Effective Date
RELIANCE STANDARD LIFE INSURANCE COMPANY RELIANCE STANDARD LIFE INSURANCE COMPANY
CENTRAL LIFE INSURANCE COMPANY OF ILLINOIS
10/23/1919
CENTRAL LIFE INSURANCE COMPANY OF ILLINOIS
CENTRAL STANDARD LIFE INSURANCE COMPANY
04/30/1951
CENTRAL STANDARD LIFE INSURANCE COMPANY
RELIANCE STANDARD LIFE INSURANCE COMPANY
08/09/1965
Info
x
No Results Found. © 2020 National Association of Insurance Commissioners. All rights reserved.
Ex. Q, p. 14
https://sbs.naic.org/solar-external-lookup/lookup/company/summary/59224409?jurisdiction=NE
2/2
8/12/2020
Company Lookup Summary
Jurisdiction: New Hampshire
Demographics Company Name: RELIANCE STANDARD LIFE INSURANCE COMPANY
Short Name: RELIANCE STANDARD LIFE INSURANCE COMPANY
SBS Company Number: 89277371
NAIC CoCode: 68381
FEIN: 36-0883760
Domicile Type: Foreign
State of Domicile: Illinois
Country of Domicile: United States
NAIC Group Number: 3098 - Tokio Marine Holdings Inc GRP
Organization Type: N/A
Date of Incorporation: 01/01/0001
Merger Flag: No
DBA Name No results found.
Address Business Address
Mailing Address
Statutory Home Office Address
Main Administrative Office Address
115 SOUTH LASALLE STREET CHICAGO, IL 60603-000
2001 MARKET ST, STE 1500 PHILADELPHIA, PA 19103
115 SOUTH LASALLE STREET CHICAGO, IL 60603-000
115 SOUTH LASALLE STREET CHICAGO, IL 60603-000
United States
United States
United States
United States
Phone, Email, Website Phone
No results found.
Website
No results found.
No results found.
Company Type Company Type: Life, Accident & Health Status: Active
Status Reason:
Status Date: 01/01/0001
Effective Date: 01/01/0001
Legacy State ID: 100900
Expiration Date: 06/14/2021
Issue Date: 02/01/1966
Approval Date: 01/01/0001
File Date: 01/01/0001
Articles of Incorporation Received: No
Article No:
COA Number:
Appointments Show 10
Showing 1 to 10 of 553 entries
entries
Line of Authority
Filter
Licensee Name
License Number
NPN
License Type
Appointment Date
Effective Date
RICK CECCHETTI
955791
955791
Insurance Producer
04/09/2001
04/09/2001
TIMOTHY TRUNCELLITO
15670613
15670613
Insurance Producer
05/14/2010
05/14/2010
PAUL GOYETTE
2253827
2253827
Insurance Producer
08/21/2018
08/21/2018
VINCENT THORNE
7229158
7229158
Insurance Producer
12/17/2003
12/17/2003
JAMES HAYS
261847
261847
Insurance Producer
02/28/2020
02/28/2020
LIAZON BENEFITS INC
2053136
9724034
Insurance Producer
02/20/2013
02/20/2013
JOSHUA BARTLETT
12879361
12879361
Insurance Producer
07/15/2019
07/15/2019
LINDA FODERA
7020683
7020683
Insurance Producer
04/07/2017
04/07/2017
JEFFREY RICH
5417528
5417528
Insurance Producer
03/13/2019
03/13/2019
BRENDAN MURRAY
5417070
5417070
Insurance Producer
07/29/2019
07/29/2019 First
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1
Expiration Date
2
3
Next
Last
Line Of Business Line of Business
Citation Type
Effective Date
Variable
408:40 - Variable
03/01/1997
III
401:1 III - Life
02/01/1966
IV
401:1 IV - Accident & Health
02/01/1966
Contact No results found.
Company Merger No results found.
Name Change History Previous Name
New Name
Effective Date
RELIANCE STANDARD LIFE INSURANCE COMPANY
© 2020 National Association of Insurance Commissioners. All rights reserved.
Ex. Q, p. 15
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1/1
8/12/2020
Company Lookup Summary
Jurisdiction: New Mexico
Demographics Company Name: Reliance Standard Life Insurance Company
Short Name:
SBS Company Number: 69239152
NAIC CoCode: 68381
FEIN: 36-0883760
Domicile Type: Foreign
State of Domicile: Illinois
Country of Domicile: United States
NAIC Group Number: 3098 - Tokio Marine Holdings Inc GRP
Organization Type: Stock
Date of Incorporation: 03/02/1907
Website
Merger Flag: No
DBA Name No results found.
Phone, Email, Website Phone Type
Number
Type
Type
Website
Other Phone
(267) 256-3500
Business Email
kurt.musselman@rsli.com
Website
www.reliancestandard.com
Business Primary Phone
(267) 256-3613
Mailing Email
paul.van.haren@rsli.com
Mailing Primary Phone
(267) 256-3664
Company Type Company Type: Insurance Company Status: Active
Status Reason:
Effective Date: 03/01/2020
Legacy State ID: 1291
Status Date: 03/26/2020 Expiration Date: 02/28/2021
Issue Date: 07/01/1965
Approval Date: 07/01/1965
File Date:
Articles of Incorporation Received: No
Article No:
COA Number:
Appointments Show 10
Showing 1 to 10 of 367 entries
entries
Filter
Licensee Name
License Number
NPN
License Type
Line of Authority
Appointment Date
Effective Date
Expiration Date
Kevin Pelletier
7238757
7238757
Insurance Producer
Accident and Health or Sickness
09/21/2007
04/23/2020
04/30/2021
James Soboleski
2322897
2322897
Insurance Producer
Accident and Health or Sickness
04/14/2017
04/23/2020
04/30/2021
Nicole Jones-Gyllstrom
7984767
7984767
Insurance Producer
Accident and Health or Sickness
05/24/2019
04/23/2020
04/30/2021
Sheryl Bonnell-Roy
7246085
7246085
Insurance Producer
Accident and Health or Sickness
04/11/2019
04/23/2020
04/30/2021
Michael Palumbo
3148497
3148497
Insurance Producer
Accident and Health or Sickness
03/01/2017
04/23/2020
04/30/2021
Adam Bruckman
1015391
1015391
Insurance Producer
Accident and Health or Sickness
07/10/2007
04/23/2020
04/30/2021
Anne Sperling
6719542
6719542
Insurance Producer
Accident and Health or Sickness
03/01/2017
04/23/2020
04/30/2021
Daniel Ryan
2695746
2695746
Insurance Producer
Accident and Health or Sickness
03/01/2017
04/23/2020
04/30/2021
Craig Hasday
407259
407259
Insurance Producer
Accident and Health or Sickness
09/30/2010
04/23/2020
04/30/2021
Martin Kooper
301063
301063
Insurance Producer
Accident and Health or Sickness
03/01/2017
04/23/2020
04/30/2021
First
Previous
1
2
3
Next
Last
Line Of Business Line of Business
Citation Type
Effective Date
Accident and Health
59A-7-3 Accident and health insurance. (Effective July 1, 2017.)
07/01/1965
Life and Annuities
59A-7-2 Life and annuity. (Effective July 1, 2017.)
07/01/1965
Variable Life and Annuity
59A-7-7 Variable life and annuity. (Effective July 1, 2017.)
07/01/1965
Contact Contact Type
Preferred Name
Mailing
Name
Margaret Thomas
Phone Other Phone: 8005313232X3961
Address Other 2001 Market St. Philadelphia, PA United States County 19103
Company Merger No results found.
Name Change History Previous Name Charter Security Life Insurance Company of Louisiana
New Name
Effective Date
Central Standard Life Insurance Company
07/03/2017
Central Standard Life Insurance Company
07/30/1965
Info
x
No Results Found. © 2020 National Association of Insurance Commissioners. All rights reserved.
Ex. Q, p. 16
https://sbs.naic.org/solar-external-lookup/lookup/company/summary/69239152?jurisdiction=NM
1/1
8/12/2020
Company Lookup Summary
Jurisdiction: Oklahoma
Demographics Company Name: RELIANCE STANDARD LIFE INSURANCE COMPANY
Short Name:
SBS Company Number: 44196159
NAIC CoCode: 68381
FEIN: 36-0883760
Domicile Type: Foreign
State of Domicile: Illinois
Country of Domicile: United States
NAIC Group Number: 3098 - Tokio Marine Holdings Inc GRP
Organization Type: Stockholder
Date of Incorporation: 11/14/1951
Merger Flag: No
DBA Name No results found.
Address Business Address
Mailing Address
Statutory Home Office Address
Main Administrative Office Address
Not Available Not Available, UN 99999
2001 MARKET ST STE 1500 PHILADELPHIA, PA 19103
2001 MARKET ST STE 1500 PHILADELPHIA, PA 19103
Not Available Not Available, UN 99999
United States
United States
United States
United States
Phone, Email, Website Phone
Website No results found.
Type
Number
Type
Mailing Primary Phone
(267) 256-3810
Mailing Email
charles.denaro@rsli.com
Mailing Fax Phone
(267) 256-0650
Statutory Home Office Primary Phone
(215) 787-4000
Company Type Company Type: Life Status: Active
Status Reason:
Status Date: 11/14/1951
Effective Date: 11/14/1951
Legacy State ID: 859426
Expiration Date:
Issue Date: 11/14/1951
Approval Date:
File Date:
Articles of Incorporation Received: No
Article No:
COA Number:
Appointments Show 10
Showing 1 to 10 of 712 entries
entries
Filter
Licensee Name
License Number
NPN
License Type
Line of Authority
Appointment Date
Effective Date
Expiration Date
SHIRLEY SCHUHART
40102902
13854531
Insurance Producer
Accident & Health or Sickness
09/15/2011
12/16/2019
12/31/2020
SCOTT DUNN
40156014
16122936
Insurance Producer
Accident & Health or Sickness
02/01/2016
12/16/2019
12/31/2020
GEOFF NEWMAN
100129747
16618383
Insurance Producer
Accident & Health or Sickness
09/16/2014
12/16/2019
12/31/2020
ROONEY INSURANCE AGENCY, INC.
100102489
963336
Insurance Producer
Accident & Health or Sickness
10/06/2009
12/16/2019
12/31/2020
MERCER HEALTH & BENEFITS LLC
100101884
8402092
Insurance Producer
Accident & Health or Sickness
06/05/2006
12/16/2019
12/31/2020
INSURICA, INC.
100104667
102436
Insurance Producer
Accident & Health or Sickness
06/15/2009
12/16/2019
12/31/2020
PROFESSIONAL REINSURANCE MKTG SVCS INC
100104021
7735726
Insurance Producer
Accident & Health or Sickness
06/15/2009
12/16/2019
12/31/2020
RICHARD CAZZELL
75479
1033112
Insurance Producer
Accident & Health or Sickness
03/03/2014
12/16/2019
12/31/2020
GALLAGHER BENEFIT SERVICES INC
11228
3234811
Insurance Producer
Accident & Health or Sickness
10/11/2009
12/16/2019
12/31/2020
EMPOWER BROKERAGE INC
10004441
9901964
Insurance Producer
Accident & Health or Sickness
06/15/2009
12/16/2019
12/31/2020
First
Previous
1
2
3
Next
Last
Line Of Business Line of Business
Citation Type
Effective Date
Accident & Health or Sickness
Accident & Health (O.S. Title 36, Section 703)
11/14/1951
Life
Life (O.S. Title 36, Section 702)
11/14/1951
Variable Life
Variable Life (O.S. Title 36, Section 6061, Section 6062)
11/14/1951
Contact No results found.
Company Merger No results found.
Name Change History Previous Name
New Name RELIANCE STANDARD LIFE INSURANCE COMPANY
Info
Effective Date
x
No Results Found.
© 2020 National Association of Insurance Commissioners. All rights reserved.
Ex. Q, p. 17
https://sbs.naic.org/solar-external-lookup/lookup/company/summary/44196159?jurisdiction=OK
1/2
8/12/2020
Company Lookup Summary
Jurisdiction: Oregon
Demographics Company Name: RELIANCE STANDARD LIFE INSURANCE COMPANY
Short Name:
SBS Company Number: 39190608
NAIC CoCode: 68381
FEIN: 36-0883760
Domicile Type: Foreign
State of Domicile: Illinois
Country of Domicile: United States
NAIC Group Number: 3098 - Tokio Marine Holdings Inc GRP
Organization Type: Other
Date of Incorporation: 01/01/1907
Merger Flag: No
DBA Name No results found.
Address Business Address
Mailing Address
Statutory Home Office Address
Main Administrative Office Address
2001 MARKET STREET STE 1500 PHILADELPHIA, PA 19103
2001 MARKET STREET SUITE 1500 PHILADELPHIA, PA 19103
111 SOUTH WACKER DR STE 4400 CHICAGO, IL 60606
2001 MARKET STREET SUITE 1500 PHILADELPHIA, PA 19103
United States
United States
United States
United States
Phone, Email, Website Phone
Type
Number
Business Primary Phone
(267) 256-3500
Mailing Primary Phone
(267) 256-3500
Statutory Home Office Primary Phone
(267) 256-3500
Main Admin Office Primary Phone
(267) 256-3500
Website
No results found.
No results found.
Company Type Company Type: Life, Accident & Health Status: Active
Status Reason:
Status Date: 10/04/1949
Effective Date: 10/04/1949
Legacy State ID: 954476
Expiration Date:
Issue Date: 10/04/1949
Approval Date: 10/04/1949
File Date:
Articles of Incorporation Received: No
Article No:
COA Number:
Line Of Business Line of Business
Citation Type
Effective Date
Life Including Variable Products
Life Incl VP - ORS 731.156
10/04/1949
Health
Health - ORS 731.162
10/04/1949
Contact Contact Type
Preferred Name
Compliance Officer
Name Charles Denaro
Phone
Business Email: Charles.Denaro@rsli.com
Business Primary Phone: (267) 256-3810 Business Toll Free Phone: (800) 351-7500
Address Other 2001 Market St - Ste 1500 Philadelphia, PA United States County 19103
Tax/Assessment
NICOLE FULMORE
Business Email: nicole.fulmore@rsli.com
Business Primary Phone: (267) 256-3926
Other ATTN: TAX/COMPLIANCE DEPT 2001 MARKET ST SUITE 1500 PHILADELPHIA, PA United States County 19103
Service of Process
CT CORPORATION SYSTEM
Other 780 COMMERCIAL ST SE, STE 100 SALEM, OR United States County 97301
Branch Offices Company Merger No results found.
Name Change History Previous Name
New Name
Effective Date
RELIANCE STANDARD LIFE INSURANCE COMPANY
Info
x
No Results Found. © 2020 National Association of Insurance Commissioners. All rights reserved.
Ex. Q, p. 18
https://sbs.naic.org/solar-external-lookup/lookup/company/summary/39190608?jurisdiction=OR
1/1
8/12/2020
Company Lookup Summary
Jurisdiction: Rhode Island
Demographics Company Name: Reliance Standard Life Insurance Company
Short Name:
SBS Company Number: 24172982
NAIC CoCode: 68381
FEIN: 36-0883760
Domicile Type: Foreign
State of Domicile: Illinois
Country of Domicile: United States
NAIC Group Number: 3098 - Tokio Marine Holdings Inc GRP
Organization Type: Separate Account
Date of Incorporation: 04/02/1907
Merger Flag: No
DBA Name No results found.
Address Business Address
Mailing Address
Statutory Home Office Address
Main Administrative Office Address
2001 Market Street, Suite 1500 Philadelphia, PA 19103
2001 Market Street, Suite 1500 Philadelphia, PA 19103
115 South LaSalle Street Chicago, IL 60603
2001 Market Street, Suite 1500 Attn: Tax Department
United States
United States
United States
Philadelphia, PA 19103 United States
Phone, Email, Website Phone
Website
Type
Number
Type
Type
Website
Business Primary Phone
(267) 256-3500
Business Email
angelica.merlino@rsli.com
Business URL
www.rsli.com
Mailing Primary Phone
(800) 351-7500
Statutory Home Office Primary Phone
(800) 351-7500
Company Type Company Type: Life Status: Active
Status Reason:
Effective Date: 04/01/2020
Legacy State ID: 1000287
Status Date: 03/17/2020 Expiration Date: 03/31/2021
Issue Date: 05/19/1965
Approval Date: 05/19/1965
File Date: 05/19/1965
Articles of Incorporation Received: No
Article No:
COA Number:
Line Of Business Line of Business
Citation Type
Effective Date
Life
Life
05/19/1965
Annuities
Life
05/19/1965
Accident and Health (Life)
Life
05/19/1965
Variable Life
Life
05/19/1965
Variable Annuities
Life
05/19/1965
Contact Contact Type
Preferred Name
Name
Service of Process Contact
Phone
Address
Charles Denaro
Branch Offices Company Merger No results found.
Name Change History Previous Name
New Name
Effective Date
Reliance Standard Life Insurance Company
© 2020 National Association of Insurance Commissioners. All rights reserved.
Ex. Q, p. 19
https://sbs.naic.org/solar-external-lookup/lookup/company/summary/24172982?jurisdiction=RI
1/1
8/12/2020
Company Lookup Summary
Jurisdiction: South Carolina
Demographics Company Name: RELIANCE STANDARD LIFE INS CO
Short Name:
SBS Company Number: 94306160
NAIC CoCode: 68381
FEIN: 36-0883760
Domicile Type: Foreign
State of Domicile: Illinois
Country of Domicile: United States
NAIC Group Number: 3098 - Tokio Marine Holdings Inc GRP
Organization Type: Stock
Date of Incorporation: 01/01/1907
Merger Flag: No
DBA Name No results found.
Address Business Address
Mailing Address
Statutory Home Office Address
Main Administrative Office Address
2001 MARKET STREET, SUITE 1500 PHILADELPHIA, PA 19103-0000
2001 Market Street, Suite 1500 Philadelphia, PA 19103
1100 East Woodfield Road, Two Woodfield Lake, Suit
2001 Market Street, Suite 1500 Philadelphia, PA 19103
United States
United States
Schaumburg, IL 60173 United States
United States
Phone, Email, Website Phone
Website
Type
Number
Type
Type
Website
Fax Phone
(267) 256-3523
paul.van.haren@rsli.com
Website
WWW.RSLI.COM
Toll Free Phone
(800) 351-7500
Website
www.reliancestandard.com
Other Phone
(267) 256-3664
Business Primary Phone
(267) 256-3500
Company Type Company Type: Life Status: Active
Status Reason:
Status Date: 05/31/2000
Effective Date: 01/01/1968
Legacy State ID: 100401
Expiration Date:
Issue Date: 01/01/1968
Approval Date: 01/01/1968
File Date: 09/23/1999
Articles of Incorporation Received: No
Article No:
COA Number:
Appointments Show 10
Showing 1 to 10 of 978 entries
entries
Licensee Name
License Number
NPN
License Type
Line of Authority
LANE GINSBERG
5652111
5652111
Insurance Producer
ALISON HLUCHOTA
15537533
15537533
Insurance Producer
BRYAN BICKLEY
2367350
2367350
Insurance Producer
WENDI DRENNON
6426394
6426394
THOMAS GANTT
2466673
2466673
Kristi Ivester
18283045
TRAVIS DAWKINS JAMES PUSATERI
Filter
Appointment Type
Appointment Date
Effective Date
Expiration Date
Accident & Health or Sickness
Local
08/27/2012
08/27/2012
09/30/2020
Accident & Health or Sickness
General
10/18/2017
10/18/2017
09/30/2020
Accident & Health or Sickness
General
05/07/2014
05/07/2014
09/30/2020
Insurance Producer
Accident & Health or Sickness
General
09/26/2012
09/26/2012
09/30/2020
Insurance Producer
Accident & Health or Sickness
General
03/16/2018
03/16/2018
09/30/2020
18283045
Insurance Producer
Accident & Health or Sickness
General
10/26/2017
10/26/2017
09/30/2020
6430433
6430433
Insurance Producer
Accident & Health or Sickness
General
04/27/2010
04/27/2010
09/30/2020
514744
514744
Insurance Producer
Accident & Health or Sickness
General
10/05/2007
10/05/2007
09/30/2020
CARROLL CARSON
643346
643346
Insurance Producer
Accident & Health or Sickness
General
04/24/2018
04/24/2018
09/30/2020
BRIAN FLYNN
5569027
5569027
Insurance Producer
Accident & Health or Sickness
Local
04/28/2010
04/28/2010
09/30/2020
First
Previous
1
2
3
Next
Last
Line Of Business Line of Business
Citation Type
Effective Date
Life
01/01/1968
Variable Contracts
01/01/1968
Accident & Health
01/01/1968
Contact Contact Type Producer Licensing Contact (Appointment)
Preferred Name Name
MARGE THOMAS
Email: marge.thomas@rsli.com
Phone Business Primary Phone: (267) 256-3961 Fax Phone: (267) 256-3540
Premium Tax Contact
Nicole Fulmore
Email: Nicole.Fulmore@rsli.com
Address Mailing Address 2001 MARKET STREET, STE 1500
Toll Free Phone: (800) 351-7500
AGENCY DEPARTMENT PHILADELPHIA, PA United States County 191030000
Business Primary Phone: (267) 256-3926
Mailing Address 2001 Market Street, Ste 1500 Tax Department Info Philadelphia, PA No Results Found. United States County
© 2020 National Association of Insurance Commissioners. All rights reserved.
Ex. Q, p. 20
https://sbs.naic.org/solar-external-lookup/lookup/company/summary/94306160?jurisdiction=SC
x
19103
1/2
8/12/2020 Contact Type
Premium Tax Contact
Company Lookup Summary Preferred Name Name
Thomas Burghart
Phone
Email: Thomas.Burghart@rsli.com
Address
Mailing Address 2001 Market Street, Ste 1500 Tax Department Philadelphia, PA United States County 19103
Branch Offices Company Merger No results found.
Name Change History Previous Name
New Name
Effective Date
RELIANCE STANDARD LIFE INS CO
01/01/1968
Info
x
No Results Found. © 2020 National Association of Insurance Commissioners. All rights reserved.
Ex. Q, p. 21
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2/2
8/12/2020
Company Lookup Summary
Jurisdiction: Wisconsin
Demographics Company Name: Reliance Standard Life Insurance Company
Short Name:
SBS Company Number: 54218354
NAIC CoCode: 68381
FEIN: 36-0883760
Domicile Type: Foreign
State of Domicile: Illinois
Country of Domicile: United States
NAIC Group Number: 3098 - Tokio Marine Holdings Inc GRP
Organization Type: Stock
Date of Incorporation: 04/12/1907
Merger Flag: No
Address Business Address 2001 MARKET ST STE 1500
Mailing Address 2001 MARKET ST STE 1500
Statutory Home Office Address 1100 E WOODFIELD RD
Main Administrative Office Address 2001 MARKET ST STE 1500
PHILADELPHIA, PA 19103 United States
PHILADELPHIA, PA 19103 United States
2 WOODFIELD LAKE SCHAUMBURG, IL 60173
PHILADELPHIA, PA 19103 United States
United States
Phone, Email, Website Phone
Type
Number
Fax Phone
(267) 256-3522
Toll Free Phone
(800) 351-7500
Business Primary Phone
(267) 256-3500
Website
No results found.
No results found.
Company Type Company Type: Life, Accident, and Health Status: Active
Status Reason:
Status Date: 09/30/1952
Effective Date: 04/12/1996
Legacy State ID: 110420
Expiration Date:
Issue Date: 09/30/1952
Approval Date:
File Date:
Articles of Incorporation Received: No
Article No:
COA Number:
Appointments Show 10
Showing 1 to 10 of 1624 entries
entries
Filter
Licensee Name
License Number
NPN
License Type
Line of Authority
Appointment Date
Effective Date
Expiration Date
JEFFREY SMITH
8766440
8766440
Intermediary (Agent) Individual
Accident & Health
12/01/2013
03/03/2020
03/15/2021
GEOFFREY BERGWALL
8741996
8741996
Intermediary (Agent) Individual
Accident & Health
04/12/2010
03/03/2020
03/15/2021
JOHN WERNER
6456846
6456846
Intermediary (Agent) Individual
Accident & Health
12/24/2009
03/03/2020
03/15/2021
JESSE OBOYLE
8147162
8147162
Intermediary (Agent) Individual
Accident & Health
08/15/2010
03/03/2020
03/15/2021
JAMES BURANT
313065
313065
Intermediary (Agent) Individual
Accident & Health
04/05/1996
03/03/2020
03/15/2021
NICK BAUER
8198904
8198904
Intermediary (Agent) Individual
Accident & Health
04/02/2014
03/03/2020
03/15/2021
MARC PAULSON
366907
366907
Intermediary (Agent) Individual
Accident & Health
09/01/2008
03/03/2020
03/15/2021
DANIEL MARTIN
322128
322128
Intermediary (Agent) Individual
Accident & Health
01/14/2005
03/03/2020
03/15/2021
THEODORE GREEN
6475268
6475268
Intermediary (Agent) Individual
Accident & Health
01/14/2014
03/03/2020
03/15/2021
DEBRA KRAEMER
6496059
6496059
Intermediary (Agent) Individual
Accident & Health
11/01/2009
03/03/2020
03/15/2021
First
Previous
1
2
3
Next
Last
Line Of Business Line of Business
Citation Type
Effective Date
Disability Insurance
Disability Insurance
09/30/1952
Life Insurance and Annuities Participating and Non-Participating
Life Insurance and Annuities Participating and Non-Participating
09/30/1952
Variable Life Insurance and Variable Annuities
Variable Life Insurance and Variable Annuities
09/28/1990
Contact Contact Type
Preferred Name
Registered Agent for Service of Process
Name *
Phone
Address Other CT CORPORATION SYSTEM 301 S BEDFORD ST STE 1 MADISON, WI United States County 53703
Company Merger No results found.
Name Change History Previous Name
New Name
Effective Date
Reliance Standard Life Insurance Company © 2020 National Association of Insurance Commissioners. All rights reserved.
Ex. Q, p. 22
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1/2
8/12/2020
Company Lookup Summary
Jurisdiction: West Virginia
Demographics Company Name: RELIANCE STANDARD LIFE INSURANCE COMPANY
Short Name:
SBS Company Number: 109404295
NAIC CoCode: 68381
FEIN: 36-0883760
Domicile Type: Foreign
State of Domicile: Illinois
Country of Domicile: United States
NAIC Group Number: 3098 - Tokio Marine Holdings Inc GRP
Organization Type: Stock
Date of Incorporation: 04/02/1907
Merger Flag: No
DBA Name No results found.
Address Business Address
Mailing Address
Statutory Home Office Address
Main Administrative Office Address
2001 MARKET ST STE 1500 PHILADELPHIA, PA 19103
2001 MARKET ST STE 1500 PHILADELPHIA, PA 19103
111 SOUTH WACKER DRIVE, SUITE 4400 CHICAGO, IL 60606-4410
115 S LA SALLE ST CHICAGO, IL 60603
United States
United States
United States
United States
Phone, Email, Website Phone
Website No results found.
Type
Number
Type
Business Primary Phone
(800) 351-7500
Mailing Email
charles.denaro@rsli.com
Mailing Primary Phone
(267) 256-3810
Mailing Fax Phone
(267) 256-0650
Statutory Home Office Primary Phone
(800) 351-7500
Main Admin Office Primary Phone
(800) 351-7500
Company Type Company Type: Life Status: Active
Status Reason: Allowed to do Business
Status Date: 05/03/2020
Effective Date: 06/01/2020
Legacy State ID: 286493
Expiration Date: 05/31/2021
Issue Date: 06/29/1965
Approval Date:
File Date:
Articles of Incorporation Received: No
Article No:
COA Number:
Appointments Show 10
Showing 1 to 10 of 343 entries
entries
Filter
Licensee Name
License Number
NPN
License Type
Line of Authority
Appointment Date
Effective Date
Expiration Date
SAMANTHA VILGA
18714860
18714860
Insurance Producer
Life
10/24/2018
06/01/2020
05/31/2021
WILLIAM ELLIOTT
3661308
3661308
Insurance Producer
Life
05/15/2014
06/01/2020
05/31/2021
THOMAS BAYLEY
1926673
1926673
Insurance Producer
Life
07/07/2016
06/01/2020
05/31/2021
RUSSELL SETTLE
3496452
3496452
Insurance Producer
Life
12/27/2018
06/01/2020
05/31/2021
JOSEPH DEACON
7826510
7826510
Insurance Producer
Life
04/20/2016
06/01/2020
05/31/2021
CHRISTOPHER PATELLA
2359762
2359762
Insurance Producer
Life
09/16/2010
06/01/2020
05/31/2021
ERIC PRITT
8490765
8490765
Insurance Producer
Life
01/31/2018
06/01/2020
05/31/2021
JAMES MEADE
1865698
1865698
Insurance Producer
Life
02/16/2016
06/01/2020
05/31/2021
JOANNE WADSWORTH
5316118
5316118
Insurance Producer
Life
08/06/2014
06/01/2020
05/31/2021
ROBERT CARTER
8408491
8408491
Insurance Producer
Life
05/17/2018
06/01/2020
05/31/2021
First
Previous
1
2
3
Next
Last
Line Of Business Line of Business
Citation Type
Effective Date
Life - Article 1, Section 10(a)
Life - Article 1, Section 10(a)
06/01/2010
Accident & Sickness - Article 1, Section 10(b)
Accident & Sickness - Article 1, Section 10(b)
06/01/2010
Contact Contact Type Complaint
Preferred Name
Name Charles Denaro
Phone
Business Email: charles.denaro@rsli.com
Business Primary Phone: (267) 256-3810
Address Other 2001 Market Street, Suite 1500 Philadelphia, PA United States County 19046
Agent Licensing
Contact
Business Primary Phone: 00
Other GERRI MARCHIAFAVA,MKTG. ADMIN. 2001 MARKET ST, STE 1500 PHILADELPHIA, PA United States County Info 191037000
Tax
Tax Department
Business Primary Phone: (800) 351-7500 © 2020 National Association of Insurance Commissioners. All rights reserved.
Ex. Q, p. 23
https://sbs.naic.org/solar-external-lookup/lookup/company/summary/109404295?jurisdiction=WV
x
No Results Found.
Other 2001 MARKET ST STE 1500 PHILADELPHIA PA
1/2
8/12/2020 Contact Type
Company Lookup Summary Preferred Name
Name
Phone
PHILADELPHIA, PA Address United States County 19103
Company Merger No results found.
Name Change History Previous Name
New Name
Effective Date
CENTRAL STANDARD LIFE INSURANCE COMPANY CENTRAL STANDARD LIFE INSURANCE COMPANY
RELIANCE STANDARD LIFE INSURANCE COMPANY
07/17/2001
Info
x
No Results Found. © 2020 National Association of Insurance Commissioners. All rights reserved.
Ex. Q, p. 24
https://sbs.naic.org/solar-external-lookup/lookup/company/summary/109404295?jurisdiction=WV
2/2
Ex. R, p. 1
Ex. R, p. 2
Ex. R, p. 3
Ex. S, p. 1
Annual Statement for the year 2019 of the
Reliance Standard Life Insurance Company
SCHEDULE T - PART 2 INTERSTATE COMPACT - EXHIBIT OF PREMIUMS WRITTEN Allocated by States and Territories
States, Etc.
1 Life (Group and Individual)
2 Annuities (Group and Individual)
Direct Business Only 3 4 Disability Income Long-Term Care (Group and (Group and Individual) Individual)
5
6
Deposit-Type Contracts
Totals
1.
Alabama.........................................................................................AL ............8,322,225 ..........20,267,846 ............7,509,708 .............................. .............................. ..........36,099,779
2.
Alaska.............................................................................................AK ............1,404,049 ...............211,638 ............2,247,409 .............................. .............................. ............3,863,096
3.
Arizona...........................................................................................AZ ............7,162,038 ..........29,268,624 ............6,369,713 .............................. .............................. ..........42,800,375
4.
Arkansas........................................................................................AR ............1,335,655 ............8,294,835 ............2,345,639 .............................. .............................. ..........11,976,129
5.
California........................................................................................CA ..........46,934,508 ..........97,531,722 ..........61,743,326 .............................. .............................. ........206,209,556
6.
Colorado........................................................................................CO ............1,567,194 ..........13,169,945 ............2,525,797 .............................. .............................. ..........17,262,936
7.
Connecticut....................................................................................CT ..........11,664,127 ..........51,068,006 ..........12,883,970 .............................. .............................. ..........75,616,103
8.
Delaware........................................................................................DE ............5,692,353 ............6,403,600 ............5,876,236 .............................. ........800,000,000 ........817,972,189
9.
District of Columbia.......................................................................DC ............1,652,881 ...............140,100 ............4,078,987 .............................. .............................. ............5,871,968
10.
Florida.............................................................................................FL ..........26,307,925 ..........87,138,048 ..........34,609,908 .............................. .............................. ........148,055,881
11.
Georgia..........................................................................................GA ..........15,551,327 ..........41,518,601 ..........15,870,508 .............................. .............................. ..........72,940,436
12.
Hawaii..............................................................................................HI ............2,406,498 ..........15,422,216 ............3,695,193 .............................. .............................. ..........21,523,907
13.
Idaho................................................................................................ID ...............478,445 ............4,735,334 ............1,843,653 .............................. .............................. ............7,057,432
14.
Illinois...............................................................................................IL ..........31,852,153 ..........45,887,030 ..........26,251,762 .............................. ........825,000,000 ........928,990,945
15.
Indiana.............................................................................................IN ..........14,724,479 ..........35,068,488 ..........22,739,058 .............................. .............................. ..........72,532,025
16.
Iowa.................................................................................................IA ............9,608,812 ..........16,870,691 ..........12,257,581 .............................. .............................. ..........38,737,084
17.
Kansas...........................................................................................KS ............7,239,811 ............6,859,135 ............7,735,984 .............................. .............................. ..........21,834,930
18.
Kentucky.........................................................................................KY ..........11,327,762 ..........17,023,896 ..........14,164,614 .............................. .............................. ..........42,516,272
19.
Louisiana........................................................................................LA ............5,745,634 ..........14,540,216 ..........10,227,394 .............................. .............................. ..........30,513,244
20.
Maine.............................................................................................ME ...............590,542 ............6,770,590 ............1,232,449 .............................. .............................. ............8,593,581
21.
Maryland........................................................................................MD ..........19,659,643 ..........15,666,164 ..........21,409,763 .............................. .............................. ..........56,735,570
22.
Massachusetts...............................................................................MA ..........23,435,880 ..........90,129,322 ..........39,846,925 .............................. .............................. ........153,412,127
23.
Michigan..........................................................................................MI ..........21,244,030 ..........70,613,437 ..........19,509,629 .............................. .............................. ........111,367,096
24.
Minnesota......................................................................................MN ............4,559,682 ..........22,011,039 ..........19,956,611 .............................. .............................. ..........46,527,332
25.
Mississippi.....................................................................................MS ...............882,976 ............8,054,148 ............1,876,115 .............................. .............................. ..........10,813,239
26.
Missouri.........................................................................................MO ............7,521,193 ..........10,962,119 ............9,826,025 .............................. .............................. ..........28,309,337
27.
Montana.........................................................................................MT ...............640,332 ...............217,759 ...............678,497 .............................. .............................. ............1,536,588
28.
Nebraska........................................................................................NE ............6,763,501 ............4,928,575 ............7,159,014 .............................. .............................. ..........18,851,090
29.
Nevada...........................................................................................NV ............1,113,415 ..........13,868,034 ...............934,533 .............................. .............................. ..........15,915,982
30.
New Hampshire.............................................................................NH ............2,196,984 ..........25,383,016 ............2,976,118 .............................. .............................. ..........30,556,118
31.
New Jersey.....................................................................................NJ ..........17,551,354 ........100,020,172 ..........26,987,250 .............................. .............................. ........144,558,776
32.
New Mexico...................................................................................NM ............1,652,647 ............1,665,886 ............2,048,128 .............................. .............................. ............5,366,661
33.
New York.......................................................................................NY ...............101,326 ...................4,081 .............................. .............................. .............................. ...............105,407
34.
North Carolina...............................................................................NC ............9,120,168 ..........63,877,633 ..........10,082,740 .............................. .............................. ..........83,080,541
35.
North Dakota..................................................................................ND ...............277,280 ...............135,035 ...............362,861 .............................. .............................. ...............775,176
36.
Ohio...............................................................................................OH ..........10,561,518 ..........63,295,565 ..........20,034,288 .............................. .............................. ..........93,891,371
37.
Oklahoma......................................................................................OK ............1,443,293 ............2,161,178 ............1,522,703 .............................. .............................. ............5,127,174
38.
Oregon...........................................................................................OR ............3,418,603 ............4,600,335 ............5,762,204 .............................. .............................. ..........13,781,142
39.
Pennsylvania..................................................................................PA ..........23,861,956 ........134,150,950 ..........36,560,451 .............................. .............................. ........194,573,357
40.
Rhode Island...................................................................................RI ...............597,161 ..........22,273,949 ...............692,423 .............................. .............................. ..........23,563,533
41.
South Carolina...............................................................................SC ............2,373,267 ..........30,997,813 ............2,972,551 .............................. .............................. ..........36,343,631
42.
South Dakota.................................................................................SD ...............592,884 .................99,113 ...............643,225 .............................. .............................. ............1,335,222
43.
Tennessee.....................................................................................TN ..........20,795,452 ..........33,742,015 ..........29,911,669 .............................. .............................. ..........84,449,136
44.
Texas..............................................................................................TX ..........16,421,979 ..........46,033,176 ..........19,419,283 .............................. .............................. ..........81,874,438
45.
Utah................................................................................................UT ............2,144,201 ............8,090,243 ............1,732,156 .............................. .............................. ..........11,966,600
46.
Vermont..........................................................................................VT ............2,351,688 ............8,790,458 ............5,211,790 .............................. .............................. ..........16,353,936
47.
Virginia...........................................................................................VA ..........10,466,145 ..........33,633,376 ..........15,563,106 .............................. .............................. ..........59,662,627
48.
Washington...................................................................................WA ............6,309,817 ..........22,497,350 ..........11,025,399 .............................. .............................. ..........39,832,566
49.
West Virginia.................................................................................WV ...............740,829 ..........14,268,024 ...............879,849 .............................. .............................. ..........15,888,702
50.
Wisconsin.......................................................................................WI ..........12,660,363 ..........39,951,879 ..........18,610,038 .............................. .............................. ..........71,222,280
51.
Wyoming.......................................................................................WY ...............785,903 ...............884,101 ...............591,851 .............................. .............................. ............2,261,855
52.
American Samoa...........................................................................AS .............................. .............................. .............................. .............................. .............................. ..........................0
53.
Guam.............................................................................................GU .............................. .............................. .............................. .............................. .............................. ..........................0
54.
Puerto Rico....................................................................................PR .............................. ............3,784,888 ...................5,924 .............................. .............................. ............3,790,812
55.
US Virgin Islands.............................................................................VI .................18,576 .............................. .............................. .............................. .............................. .................18,576
56.
Northern Mariana Islands..............................................................MP .............................. .............................. .............................. .............................. .............................. ..........................0
57.
Canada........................................................................................CAN ......................865 .............................. .............................. .............................. .............................. ......................865
58.
Aggregate Other Alien...................................................................OT .............................. .............................. .............................. .............................. .............................. ..........................0
59.
Totals................................................................................................... ........443,833,329 .....1,414,981,394 ........591,002,008 ..........................0 .....1,625,000,000 .....4,074,816,731
50 Ex. S, p. 2
Annual Statement for the year 2019 of the
Reliance Standard Life Insurance Company
SCHEDULE Y - INFORMATION CONCERNING ACTIVITIES OF INSURER MEMBERS OF A HOLDING COMPANY GROUP PART 1 - ORGANIZATIONAL CHART Group Name
Name of Company
51
Tokio Marine Holdings, Inc. Tokio Marine & Nichido Fire Insurance Co., Ltd. TM Claims Service, Inc. Tokio Marine North America, Inc. Tokio Marine America Insurance Company Trans Pacific Insurance Company TM Specialty Insurance Company Tokio Marine Management, Inc. TNUS Insurance Company TMNA Services, LLC Philadelphia Consolidated Holding Corp. Tokio Marine Specialty Insurance Company Philadelphia Indemnity Insurance Company PCHC Investment Corp. Maguire Insurance Agency, Inc. Gillingham & Associates, Inc. The Allen J. Flood Companies, Inc. Select Communities Risk Purchasing Group, LLC First Insurance Company of Hawaii, Ltd. First Risk Management Services, Inc. First Fire and Casualty Insurance of Hawaii, Inc. First Indemnity Insurance of Hawaii, Inc. First Security Insurance of Hawaii, Inc. J.M. Lydgate, Limited Tokio Marine GRV Re, Inc. Delphi Financial Group, Inc. Reliance Standard Life Insurance Company of Texas Reliance Standard Life Insurance Company First Reliance Standard Life Insurance Company Delphi Project Foundation Insurance Dedicated Fund LLC Flat Rock Holdings LLC Flat Rock Mortgage Investment Trust Flat Rock Properties LLC Quercus Mortgage Investment Trust Riverview Mortgage Investment Trust SIG Holdings, Inc. Safety National Casualty Corporation Safety First Insurance Company Midlands Management Corporation Midlands Claim Administrators, Inc. Midlands Management of Texas, Inc. Safety National Re SPC Tokio Marine RSL Re PIC, Ltd. Safety National Re PIC 1, Ltd.
Insurance Company X (Non Insurer) (Non Insurer) X X X (Non Insurer) X (Non Insurer) (Non-Insurer) X X (Non-Insurer) (Non-Insurer) (Non-Insurer) (Non-Insurer) (Non-Insurer) X (Non Insurer) X X X (Non Insurer) X (Non Insurer) X X X (Non Insurer) (Non Insurer) (Non Insurer) (Non Insurer) (Non Insurer) (Non Insurer) (Non Insurer) (Non Insurer) X X (Non Insurer) (Non Insurer) (Non Insurer) X X X
Ex. S, p. 3
Percentage Owned(*) 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 78.9% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%
NAIC Company Code
10945 41238 10738 32301
23850 18058
41742 41726 41734 10938 11243 66575 68381 71005
15105 11123
State of Domicile or Port of Entry Japan Japan New York Delaware New York New York Arizona New York New York Delaware Pennsylvania Delaware Pennsylvania Delaware Pennsylvania Colorado New York Delaware Hawaii Hawaii Hawaii Hawaii Hawaii Hawaii Oklahoma Delaware Texas Illinois New York Pennsylvania Delaware Delaware Delaware Delaware Delaware Delaware Delaware Missouri Illinois Oklahoma Oklahoma Texas Cayman Islands Cayman Islands Cayman Islands
Federal ID Number
Alien ID AA-1580100
13-3382776 45-2682016 13-4032666 13-3118700 91-1932966 13-2871816 20-0940754 45-2682309 23-2202671 23-2423138 23-1738402 51-0385989 23-1609281 84-1181504 13-1924482 82-2604107 99-0218317 13-4267947 99-0218320 99-0218318 99-0335740 99-0046912 76-0699782 13-3427277 74-2281123 36-0883760 13-3176850 23-2711230 36-0883760 27-3562945 27-3562945 27-3562945
51-0374001 43-0727872 43-1901552 73-1366980 73-1446969 75-1298078 AA-3770149 AA-3770493
Annual Statement for the year 2019 of the
Reliance Standard Life Insurance Company
SCHEDULE Y - INFORMATION CONCERNING ACTIVITIES OF INSURER MEMBERS OF A HOLDING COMPANY GROUP PART 1 - ORGANIZATIONAL CHART Group Name
Name of Company
51.1
Safety Specialty Insurance Company Insurance Data Services Corporation Greenbrook LLC TER I, LLC Matrix Absence Management, Inc. Matrix Payroll Services, Inc. Delphi Capital Management, Inc. Chestnut Investors IV, Inc. Tersk Investors LLC Delphi CRE Funding LLC Tokio Marine Management (Canada) Ltd. Tokio Marine Seguradora S.A. Tokio Marine & Nichido Fire Insurance Co., Ltd. - Escritorio de Representacao no Brasil Ltda. Tokio Marine Compañía de Seguros, S.A. de C.V. Tokio Marine Middle East Limited TM Claims Service Europe Limited The Arab-Eastern Insurance Co. Ltd. E.C. Tokio Marine Management (Australasia) Pty. Ltd. Bond and Credit Company Pty Ltd BCC Trade Credit Pty Ltd BCC Surety Pty Ltd Accident & Health International Underwriting Pty Ltd Tokio Marine Pacific Insurance Limited TM Claims Service Asia Pte. Limited Asia General Holdings Limited Tokio Marine Insurance Singapore Ltd. Tokio Marine Life Insurance Singapore Ltd. Tokio Marine Life Insurance Malaysia Bhd. Tokio Marine Insurance (Thailand) Public Company Limited PT Tokio Marine Life Insurance Indonesia Tokio Marine Kiln Group Limited Tokio Marine Kiln Insurance Limited Tokio Marine Europe Limited Kiln Underwriting (807) Limited Kiln Underwriting (807) No 2 Limited Kiln Underwriting (No. 308) Limited Kiln Underwriting (510) Limited R J Kiln & Co (No 2) Limited WNC GP, LLC WNC Holding Company, LP WNC Insurance Holding Corp. WNC Insurance Services, Inc. Precise Adjustments, Inc. Insurance Management Services, Inc. AMPAC Insurance Marketing, Inc.
Insurance Company
Percentage Owned(*)
X (Non Insurer) (Non Insurer) (Non Insurer) (Non Insurer) (Non Insurer) (Non Insurer) (Non Insurer) (Non Insurer) (Non Insurer) (Non Insurer) X (Non Insurer) X (Non Insurer) (Non Insurer) X (Non Insurer) (Non Insurer) (Non Insurer) (Non Insurer) (Non Insurer) X (Non Insurer) (Non Insurer) X X X X X (Non Insurer) X (Non Insurer) X X X X (Non Insurer) (Non Insurer) (Non Insurer) (Non Insurer) (Non Insurer) (Non Insurer) (Non Insurer) (Non Insurer)
100.0% 100.0% 100.0% 82.7% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 97.8% 95.0% 100.0% 100.0% 100.0% 33.3% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 92.4% 92.4% 79.3% 79.3% 99.9% 97.8% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%
Ex. S, p. 4
NAIC Company Code 13815
11216
State of Domicile or Port of Entry
Federal ID Number
Missouri Missouri Delaware Delaware Delaware California Delaware Delaware Delaware Delaware Canada Brazil Brazil Mexico UAE UK Bahrain Australia Australia Australia Australia Australia Guam Singapore Singapore Singapore Singapore Malaysia Thailand Indonesia UK UK UK UK UK UK UK UK California Delaware Delaware California Texas Texas California
27-2237608 45-3123432 22-3704234 52-2284613 77-0493584 77-0246850 52-1658222 23-2513246 13-3439651 13-3427277
Alien ID
66-0571597
AA-5780001
AA-1121445
Annual Statement for the year 2019 of the
1
Group Code
2
Group Name
3
NAIC Company Code
Reliance Standard Life Insurance Company 4
ID Number
5
Federal RSSD
6
CIK
7 Name of Securities Exchange if Publicly Traded (U.S. or International)
SCHEDULE Y
PART 1A - DETAIL OF INSURANCE HOLDING COMPANY SYSTEM 8
Names of Parent, Subsidiaries or Affiliates
9
10
Relationship Domiciliary to Reporting Location Entity
11
Directly Controlled by (Name of Entity/Person)
........ ............................................... ............. 52-2284613.. ................... ................... ......................... TER I, LLC.......................................................... DE............. NIA............... Reliance Standard Life Insurance Company
12 13 Type of Control (Ownership Board, If Control is Management, Ownership Attorney-in-Fact, Provide Influence, Other) Percentage
14
15
16
Ultimate Controlling Entity(ies)/Person(s)
Is an SCA Filing Required? (Y/N)
*
Ownership......... ........0.235 Tokio Marine Holdings, Inc. ............................. ......N....... .............
........ ............................................... ............. 52-2284613.. ................... ................... ......................... TER I, LLC.......................................................... DE............. NIA............... Safety National Casualty Corporation.............. Ownership......... ........0.251 Tokio Marine Holdings, Inc. ............................. ......N....... ............. ........ ............................................... ............. 52-2284613.. ................... ................... ......................... TER I, LLC.......................................................... DE............. NIA............... Delphi Financial Group, Inc.............................. Ownership......... ........0.035 Tokio Marine Holdings, Inc. ............................. ......N....... ............. ........ ............................................... ............. 52-2284613.. ................... ................... ......................... TER I, LLC.......................................................... DE............. NIA............... Philadelphia Indemnity Insurance Company.... Ownership......... ........0.306 Tokio Marine Holdings, Inc. ............................. ......N....... ............. ........ ............................................... ............. 36-0883760.. ................... ................... ......................... Insurance Dedicated Fund LLC.......................... DE............. NIA............... Reliance Standard Life Insurance Company.... Ownership......... ........1.000 Tokio Marine Holdings, Inc. ............................. ......N....... ............. ........ ............................................... ............. 27-3562945.. ................... ................... ......................... Flat Rock Holdings LLC...................................... DE............. NIA............... Reliance Standard Life Insurance Company.... Ownership......... ........0.789 Tokio Marine Holdings, Inc. ............................. ......N....... ............. ........ ............................................... ............. 27-3562945.. ................... ................... ......................... Flat Rock Mortgage Investment Trust................ DE............. NIA............... Flat Rock Holdings LLC.................................... Ownership......... ........0.789 Tokio Marine Holdings, Inc. ............................. ......N....... ............. ........ ............................................... ............. 27-3562945.. ................... ................... ......................... Flat Rock Properties LLC................................... DE............. NIA............... Flat Rock Mortgage Investment Trust.............. Ownership......... ........0.789 Tokio Marine Holdings, Inc. ............................. ......N....... ............. ........ ............................................... ............. ..................... ................... ................... ......................... Quercus Mortgage Investment Trust.................. DE............. NIA............... Reliance Standard Life Insurance Company.... Ownership......... ........1.000 Tokio Marine Holdings, Inc. ............................. ......N....... ............. ........ ............................................... ............. ..................... ................... ................... ......................... Riverview Mortgage Investment Trust................ DE............. NIA............... Reliance Standard Life Insurance Company.... Ownership......... ........1.000 Tokio Marine Holdings, Inc. ............................. ......N....... ............. ........ ............................................... ............. 51-0374001.. ................... ................... ......................... SIG Holdings, Inc............................................... DE............. NIA............... Delphi Financial Group, Inc.............................. Ownership......... ........1.000 Tokio Marine Holdings, Inc. ............................. ......N....... ............. Tokio Marine Holdings, Inc. 3098 GRP
52.1
Tokio Marine Holdings, Inc. 3098 GRP
15105... 43-0727872.. ................... ................... ......................... Safety National Casualty Corporation................ MO............ IA.................. SIG Holdings, Inc............................................. Ownership......... ........1.000 Tokio Marine Holdings, Inc. ............................. ......Y....... ............. 11123... 43-1901552.. ................... ................... ......................... Safety First Insurance Company........................ IL............... IA.................. Safety National Casualty Corporation.............. Ownership......... ........1.000 Tokio Marine Holdings, Inc. ............................. ......N....... .............
........ ............................................... ............. 73-1366980.. ................... ................... ......................... Midlands Management Corporation................... OK............. NIA............... Safety National Casualty Corporation.............. Ownership......... ........1.000 Tokio Marine Holdings, Inc. ............................. ......N....... ............. ........ ............................................... ............. 73-1446969. ................... ................... ......................... Midlands Claim Administrators, Inc.................... OK............. NIA............... Midlands Management Corporation................. Ownership......... ........1.000 Tokio Marine Holdings, Inc. ............................. ......N....... ............. ........ ............................................... ............. 75-1298078.. ................... ................... ......................... Midlands Management of Texas, Inc................. TX............. NIA............... Midlands Management Corporation................. Ownership......... ........1.000 Tokio Marine Holdings, Inc. ............................. ......N....... ............. ........ ............................................... ............. AA-3770149. ................... ................... ......................... Safety National Re SPC..................................... CYM.......... IA.................. Safety National Casualty Corporation.............. Ownership......... ........1.000 Tokio Marine Holdings, Inc. ............................. ......N....... ............. ........ ............................................... ............. ..................... ................... ................... ......................... Safety National Re PIC 1, Ltd............................ CYM.......... IA.................. Safety National Re SPC................................... Ownership......... ........1.000 Tokio Marine Holdings, Inc. ............................. ......N....... ............. ........ ............................................... ............. AA-3770493. ................... ................... ......................... Tokio Marine RSL Re PIC, Ltd........................... CYM.......... IA.................. Safety National Re SPC................................... Ownership......... ........1.000 Tokio Marine Holdings, Inc. ............................. ......N....... ............. Tokio Marine Holdings, Inc. 3098 GRP
13815... 27-2237608.. ................... ................... ......................... Safety Specialty Insurance Company................ MO............ IA.................. Safety National Casualty Corporation.............. Ownership......... ........1.000 Tokio Marine Holdings, Inc. ............................. ......N....... .............
........ ............................................... ............. 22-3704234.. ................... ................... ......................... Greenbrook LLC................................................. DE............. NIA............... Safety National Casualty Corporation.............. Ownership......... ........1.000 Tokio Marine Holdings, Inc. ............................. ......N....... ............. ........ ............................................... ............. 45-3123432.. ................... ................... ......................... Insurance Data Services Corporation................ MO............ NIA............... Safety National Casualty Corporation.............. Ownership......... ........1.000 Tokio Marine Holdings, Inc. ............................. ......N....... ............. ........ ............................................... ............. 77-0493584.. ................... ................... ......................... Matrix Absence Management, Inc...................... DE............. NIA............... Delphi Financial Group, Inc.............................. Ownership......... ........1.000 Tokio Marine Holdings, Inc. ............................. ......N....... ............. ........ ............................................... ............. 77-0246850.. ................... ................... ......................... Matrix Payroll Services, Inc................................ CA............. NIA............... Matrix Absence Management, Inc.................... Ownership......... ........1.000 Tokio Marine Holdings, Inc. ............................. ......N....... ............. ........ ............................................... ............. 52-1658222.. ................... ................... ......................... Delphi Capital Management, Inc........................ DE............. NIA............... Delphi Financial Group, Inc.............................. Ownership......... ........1.000 Tokio Marine Holdings, Inc. ............................. ......N....... ............. ........ ............................................... ............. 23-2513246.. ................... ................... ......................... Chestnut Investors IV, Inc.................................. DE............. NIA............... Delphi Financial Group, Inc.............................. Ownership......... ........1.000 Tokio Marine Holdings, Inc. ............................. ......N....... ............. ........ ............................................... ............. 13-3439651.. ................... ................... ......................... Tersk Investors LLC........................................... DE............. NIA............... Delphi Financial Group, Inc.............................. Ownership......... ........0.522 Tokio Marine Holdings, Inc. ............................. ......N....... ............. ........ ............................................... ............. 13-3439651.. ................... ................... ......................... Tersk Investors LLC........................................... DE............. NIA............... Safety National Casualty Corporation.............. Ownership......... ........0.252 Tokio Marine Holdings, Inc. ............................. ......N....... ............. ........ ............................................... ............. 13-3439651.. ................... ................... ......................... Tersk Investors LLC........................................... DE............. NIA............... Reliance Standard Life Insurance Company.... Ownership......... ........0.226 Tokio Marine Holdings, Inc. ............................. ......N....... ............. ........ ............................................... ............. 13-3427277.. ................... ................... ......................... Delphi CRE Funding LLC................................... DE............. NIA............... Delphi Financial Group, Inc.............................. Ownership......... ........1.000 Tokio Marine Holdings, Inc. ............................. ......N....... ............. Tokio Marine & Nichido Fire Insurance Co., ........ ............................................... ............. ..................... ................... ................... ......................... Tokio Marine Management (Canada) Ltd........... CAN.......... NIA............... Ltd.
Ownership......... ........1.000 Tokio Marine Holdings, Inc. ............................. ......N....... .............
Tokio Marine & Nichido Fire Insurance Co., ........ ............................................... ............. ..................... ................... ................... ......................... Tokio Marine Seguradora S.A............................ BRA.......... IA.................. Ltd.
Ownership......... ........0.978 Tokio Marine Holdings, Inc. ............................. ......N....... .............
Ex. S, p. 5